Provider Relationship Account Manager Sr. at Elevance Health in Ashburn, Virginia

Job Description:

The Provider Relationship Account Manager Sr. is responsible for providing quality, accessible and comprehensive service to the company's provider community.



Location: The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. This is a hybrid position and will require 1-2 days per week in the office.



How you will make an impact:

• 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.
  
  


• 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.
  
  


• 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.