Provider Relationship Account Manager

3 weeks ago

Palo Alto, United States Elevance Health Full time

Carelon Behavioral Health, Inc. is enthusiastically supporting the launch of the Statewide School-Based Fee Schedule project by the Department of Health Care Services (DHCS) as the dedicated Third-Party Administrator. Our goal? To improve the mental health services offered to California's young students via this pivotal initiative.

We're expanding our team and eager to connect with professionals experienced in healthcare administration, network management, provider credentialing, and data analysis.

With this project, we're aligning our goals with Governor Newsom's Kids’ Mental Health and the Children and Youth Behavioral Health Initiative (CYBHI). We're working closely with DHCS, the Department of Managed Health Care (DMHC), and the California Department of Insurance (CDI) to implement a multi-payer fee schedule, ensuring fair reimbursement for school-linked providers offering designated outpatient mental health and substance use disorder services.

Provider Relationship Account Manager (Behavioral Health) - CALIFORNIA

This is an Individual Contributor role.

Location: This position will work a Hybrid model (remote and office). Ideal candidates must live in the state of California within 50 miles from one of our Elevance Health CA corporate offices. This position will travel to worksites and other locations as necessary.

*Seeking candidates that reside in either: Northern California, Bay Area, Central Coast or Southern California.

Work Shift: Monday thru Friday, 5 days a week during Pacific Standard Time business hours.

The Provider Relationship Account Mgr is responsible for providing quality, accessible and comprehensive service to the company's provider community.

How you will make an impact:

  • Develop and maintain positive relationships with the Local Education Agencies (LEAs), County Office of Education and 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.

  • Serve 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.

  • Collaborate 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. Generally, is assigned to a portfolio of providers within a defined cohort.

  • May assist Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues.

  • Coordinate communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.

  • Conduct proactive outreach to support the understanding of the Children and Youth Behavioral Health Initiative (CYBHI), managed care policies and procedures, as well as on a variety of initiatives and programs.

  • Participate in external Provider Townhalls/Seminars/Workshops.

  • Identify 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 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.

Preferred Skills, Capabilities and Experiences:

  • Experience working in the behavioral health field.

  • Experience working with providers.

  • Experience in the education system.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $67,368 to $115,488.

Location: California

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

  • The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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