Case Manager, Community
Nation's Finest
Provider Relationship Account Consultant
Elevance Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Kansas
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 via email, telephonic and/or face-to-face outreach.
- Communicates administrative and programmatic changes, facilitates provider education, and resolves provider issues.
- Collaborates with internal matrix partners to triage issues and submit work requests.
- Assigned to a portfolio of providers within a defined cohort; researches, analyzes, and coordinates resolution to provider issues and appeals.
- Coordinates communication on administrative and medical policy, reimbursement, and provider utilization patterns.
- Conducts routine outreach and provider training; develops and distributes provider relations materials.
- Assists with provider satisfaction surveys, corrective action plan implementation, provider manual updates and monitoring education and non-routine claim issues.
- Identifies and reports on provider utilization patterns and issues impacting network retention or contract negotiations.
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.
- Travel to worksite and other locations as necessary (preferred).
- Claims experience is strongly preferred.
- Kansas Medicaid regulatory knowledge strongly preferred.
- Kansas Provider specific experience preferred.
- Provider Servicing experience strongly preferred.
- May require COVID-19 and Influenza vaccination for certain patient/member-facing roles (offer may be rescinded if not vaccinated unless acceptable explanation provided).
