🚀 Network Relations Consultant

Network Relations Consultant

Anticipated End Date:

Location

Hybrid – Office 1-2 days per week with remote flexibility. Candidates must be within commuting distance unless an accommodation is granted.

Job Overview

The Network Relations Consultant develops and maintains positive provider relationships through regular on-site visits, communication of administrative and programmatic changes, and facilitation of provider education and issue resolution.

Responsibilities

• Serve as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researching and resolving complex provider issues and appeals for prompt resolution.
• May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
• Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
• May participation in Joint Operation Committees (JOC) of larger provider groups.
• Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
• Conducts seminars to support the understanding of managed care policies and procedures.
• Identifies network access and deficiencies and develops recruitment and contracting strategies.
• Coordinates and conducts provider training including developing and distributing provider relations materials.
• Responsible for providing quality, accessible and comprehensive service to the company's provider community.
• Provide assistance regarding education, contract questions and non-routine claim issues.
• Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
• Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department.
• Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
• Tracks and conduct provider refresher training. Researches issues that may impact future provider negotiations or jeopardize network retention.

Minimum Requirements

• Bachelor's degree and a minimum of 3 years customer service experience including 2 years as a Network Management Representative (or equivalent combination of education and experience).

Preferred Skills, Capabilities, and Experiences

• Provider-facing experience strongly preferred.
• Claims experience strongly preferred.
• Maryland Medicaid experience preferred.
• Billing from Provider experience preferred.

Salary Range

Salary range: $64,512 to $96,768 (based on location, experience, education).

EEO Statement

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.