Provider Relationship Account Manager
Elevance Health
Provider Relationship Account Manager – Escalation Advocate
Elevance Health
full-time
Posted on:
Origin: • 🇺🇸 United States • California, New York
Visit company websiteSalary
💰 $69,048 - $118,368 per year
Job Level
Mid-LevelSenior
About the role
- 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.
Requirements
- 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.
- Travels to worksite and other locations as necessary.
- Provider interface experience strongly preferred.
- Maryland Medicaid or Public Sector Medicaid account knowledge strongly preferred
- For candidates working in person in the below location(s), the salary range for this specific position is $69,048 to $118,368
- Must be within a reasonable commuting distance from the posting location(s) unless an accommodation is granted as required by law.
- May require COVID-19 and Influenza vaccination for certain patient/member-facing roles.
