Provider Relationship Account Mgr Sr at Elevance Health in Hanover, Maryland

Job Description:

Location: Must live within 50 miles of a Maryland PlusePoint office.


Responsible for providing quality, accessible and comprehensive service to the company's provider community.



How you will make an impact:

• Develops and maintains positive provider relationships with 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.


• Serves as a knowledge and resource expert regarding complex provider issues impacting provider satisfaction; research, 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 with 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. Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery.


• Organizes and executes external Provider Town Halls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA).


• Research complex issues that may impact future provider contract negotiations or jeopardize network retention.


• May be responsible for monitoring department metrics, provider assignments and oversight of daily activities and provide feedback to manager on performance management, day-to-day training, guidance, and workflow of Provider Relationship Account Mgt. Consultants/Managers.

• Requires a bachelor's degree; a minimum of 5 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. Travels to worksite and other locations as necessary.