Provider Relationship Account Mgr (US)
Elevance Health

Job Info

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Location: Primarily work from home, Must report to the KS-TOPEKA Pulse Point one time per week.

Shift: Monday-Friday, 8:00am-5:00pm CST

Responsible for providing quality, accessible and comprehensive service to the company's provider community. Develops and maintains positive provider relationships with the provider community by regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.

Primary duties may include, but are not limited to:

• Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention; researches, analyzes, and coordinates prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners.
• Collaborates within a cohort of internal matrix partners to triage issues and submit work requests. Generally, is assigned to a portfolio of providers within a defined cohort. Coordinates Joint Operation Committees (JOC) of provider groups, driving the meetings in the discussion of issues and changes.
• May assist Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues.
• Coordinates communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.
• Conducts proactive outreach to support the understanding of managed care policies and procedures, as well as on a variety of initiatives and programs.
• Participates in external Provider Townhalls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA).
• Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery.
• Research issues that may impact future provider contract negotiations or jeopardize network retention.
• Travels to worksite and other locations as necessary.

Requirements:

• a bachelor's degree; minimum of 3 years of customer service experience including 2 years of experience in a healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background.

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