Clinical Pharmacist Consultant
SmithRx
Account Consultant – Provider Relationships
Elevance Health
full-time
Posted on:
Location: North Carolina • 🇺🇸 United States
Visit company websiteJob Level
JuniorMid-Level
About the role
- Responsible for providing quality, accessible and comprehensive service to the company's provider community. 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 request 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
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 Qualifications: Travels to worksite and other locations as necessary. Experience with presentations to large groups as well as leadership strongly preferred Familiarity with Department of Social Services Initiative in North Carolina Provider Networking experience is a must have Provider facing experience is a must have Claims analysis experience strongly preferred Experience with presentations to large groups as well as leadership strongly preferred
