Network Relations Consult (US)-7
Elevance Health

Job Info

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LTSS Network Relations Consultant

Travel - this position will require you to travel 3 - 4 days per week in the following territories: Kissimmee, Orlando, Winter Haven, Sanford and Titusville Region 7

How you will make an impact:

• Develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.
• Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution.
• May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
• Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
• May participation in Joint Operation Committees (JOC) of larger provider groups.
• Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
• Conducts seminars to support the understanding of managed care policies and procedures.
• Identifies network access and deficiencies and develops recruitment and contracting strategies.
• Coordinates and conducts provider training including developing and distributing provider relations materials.
• Responsible for providing quality, accessible and comprehensive service to the company's provider community.
• Provide assistance regarding education, contract questions and non-routine claim issues.
• Coordinates communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.
• Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department.
• Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery.
• Tracks and conduct provider refresher training.
• Research issues that may impact future provider negotiations or jeopardize network retention.

Minimum Requirements:

• Requires a bachelor's degree and a minimum of 3 years of customer service experience including 2 years' experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.
• Travels to worksite and other locations, as necessary.

Preferred Skills, Capabilities, and Experiences:

• Long term care experience
• Assisted living facilities
• Experience working with Medicaid providers

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