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Network Management Representative

4 months ago

Great Neck, United States Elevance Health Full time

Network Management Representative

Location : This is a remote position. Ideal candidates will live within 50 miles of an Elevance Health PulsePoint office location in California, Colorado or in the Eastern time zone.

A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

The Network Management Representative provides comprehensive services to the provider community through researching more complex provider issues.

How you will make an impact :

  • Process Out-of-Network / Single Case Agreement requests adhering to the Carelon SCA Policy.

  • Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction.

  • Researches and resolves the complex provider issues and appeals for prompt resolution.

  • Coordinates prompt claims resolution through direct contact with providers and claims department.

  • Provides assistance with policy interpretation.

  • Researches, analyzes and recommends resolution of provider disputes, issues with billing, and other practices.

  • Assists providers with provider demographic changes as appropriate. Responds to provider issues related to billing, pricing, policy, systems and reimbursements.

  • Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.

  • Determines if providers were paid according to contracted terms.

Minimum Requirements :

  • Requires a H.S. diploma and a minimum of 3 years of customer service experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities & Experiences:

  • Experience in healthcare preferred.

  • Behavioral health experience preferred.

  • Knowledge of health insurance, contracts and networks.

  • Data entry and administrative experience preferred.

  • Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $19.81 to $35.66/h.

Locations: California; Colorado; District of Columbia (Washington, DC); New York.

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, nondiscriminatory 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.