Senior Technology Business Consultant
FIS
Provider Relationship Account Consultant
Elevance Health
full-time
Posted on:
Location: North Carolina • 🇺🇸 United States
Visit company websiteJob Level
JuniorMid-Level
About the role
- Provide 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
- 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.
- 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
