Network Relations Consult (US)-2 at Elevance Health in Tampa, Florida

Job Description:

Job Description



LTSS Network Relation
s Consultant




Travel - this position will require you to travel 3 - 4 days per week in the following territories: Tallahassee, Lake City, Perrie, Madison, Monticello and Crawfordville.
Region 2




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.

• 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.

• long term care experience.


• Assisted living facilities.


• experience working with Medicaid providers.