Job Information
Elevance Health Provider Relationship Account Mgr (US) in GRAND PRAIRIE, Texas
Provider Relationship Account Manager
Locations: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
The Provider Relationship Account Manager will be responsible for providing quality, accessible and comprehensive service to the company's provider community.
How you will make an impact:
Develops and maintains positive provider relationships with the provider community by regular 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.
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.
Minimum Qualification:
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.
Preferred Skills, Capabilities and Experiences:
Experience with Provider Claims preferred.
Experience with Medicare, Medicaid and Marketplace Care preferred.