Provider Relationship Account Consultant

2 weeks ago

Woodland Hills, United States Elevance Health Full time

Job Family: PND > Provider Relationship Account Mgmt

Type: Full time

Date Posted: May 14, 2024

Anticipated End Date: Jun 14, 2024

Reference: JR110116

Description

**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 Consultant (Behavioral Health) - CALIFORNIA
**Work Shift**:Monday thru Friday, 5 days a week during Pacific Standard Time business hours.
**The **Provider Relationship Account Consultant (Behavioral Health) **is responsible for providing quality, accessible and comprehensive service to the company's provider community.

**How you will make an impact**:

- Collaborates with internal matrix partners to triage issues and submit work requests.
- Generally assigned to a portfolio of providers within a defined cohort.
- 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.

**Minimum 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.

**Preferred Skills, Capabilities and Experiences**:

- Experience working in the behavioral health field.
- Experience in education system.
- Experience with Medi-Cal.

Location: California
- 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.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our busine

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