Provider Experience Manager at Elevance Health in Mason, Ohio

Job Description:

Locations: Mason OH, Columbus OH, Seven Hills OH, Cincinnati OH




Hours: Monday - Friday




Travel: Hybrid (1-2 days per week)




Position Overview:



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.



How You Will Make an Impact:

• 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
  
  

• Requires 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.
  
  

• Provider relations experience strongly preferred
  
  


• Provider contract language preferred
  
  


• Ohio Medicaid experience strongly preferred
  
  


• Public speaking experience preferred
  
  


• Medicaid professional and facility Claims/billing knowledge preferred