Provider Relationship Account Cons (US) at Elevance Health in Wallingford, Connecticut

Job Description:

Location:



Elevance Health supports a hybrid workplace model (virtual and office) with PulsePoint sites used for collaboration, community, and connection, with the minimum in-office commitment being 1-3 days in an office per week.


Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.



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



PRIMARY DUTIES:

• Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and/or face-to-face outreach, by communicating administrative and programmatic changes, facilitating provider education and the resolution of provider issues.


• Collaborates with internal matrix partners to triage issues and submit work requests.


• Generally assigned to a portfolio of providers within a defined cohort.


• Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners.


• Coordinates communication process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.


• Conducts routine outreach to support the understanding of managed care policies and procedures, as well as outreach on a variety of initiatives and programs.


• Coordinates and conducts provider training including developing and distributing provider relations materials.


• May assist with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education and non-routine claim issues.


• May coordinate Provider Manual updates/maintenance.


• 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.

Minimum Requirements:



Requires a bachelor's degree; a minimum of 2 years of customer service experience including 1 year of experience in a healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background.



Preferred Skills, Capabilities and Experience:

• Travels to worksite and other locations as necessary.

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