LTSS Network Relations Consultant Sr
2 weeks ago
**Location:** Sacramento CA, Woodland Hills CA, Costa Mesa CA, Palo Alto CA, Walnut Creek CA
**Hours:** Standard M - F
**Travel:** Hybrid (1-2 days onsite per week)
**Position Overview:**
The HCBS Contracting Network Specialists would initiate, negotiate, and execute HCBS providers contracts and directly support recruitment and onboarding of those providers.
**How You Will Make an Impact:**
+ The Provider Contracting Specialists would communicate contract terms, payment structures, and reimbursement rates to provider and maintains positive provider relationships
+ Maintains and tracks contracts and documentation within a tracking system
+ May assist with identifying and recruiting providers based on network composition and needs.
+ Serving as a knowledge expert regarding HCBS provider contracting
+ Responsible for negotiating and executing contracts for new and existing providers
+ Functions as a high level technical resource to resolve or facilitate complex provider issues
+ Participates in Joint Operation Committees (JOC) of larger provider groups and participates in the discussion of issues and changes
+ Provide assistance regarding education, contract questions and non-routine claim issues
+ Coordinates communications 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 conducts provider training
+ Researches issues that may impact future provider negotiations or jeopardize network retention
**Required Qualifications:**
+ Requires a Bachelor's degree and a minimum of 5 years of customer service experience including 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.
**Preferred Qualifications:**
+ Provider contracting skills, including contract preparation and implementation, financial analysis and rate proposal development is a must
+ Provider contract negotiation and execution experience preferred
+ Experience with HCBS Providers strongly preferred
+ Experience managing credentialing processes preferred
+ Provider recruitment experience preferred
+ Experience with program implementations preferred
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $67,680 to $ 121,824
Location(s): 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 Companys sole discretion, consistent with the law.
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