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LTSS Network Relations Consultant Sr.

3 months ago

Roanoke, United States Elevance Health Full time

LOCATION: This is a hybrid role requiring 1-2 days per week in the office. You must be within 50 miles of Richmond, Norfolk, or Roanoke, and Virginia residency is required. HOURS: General business hours, Monday through Friday. TRAVEL: Travels to worksite and other locations as necessary. The Network Relations Consultant Sr. develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues. Primary duties include but are not limited to: Serve as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution. May be responsible for coordinating non-negotiated contracts for new and existing providers as needed. Functions as a high level technical resource to resolve or facilitate complex provider issues. 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. 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 Previous LTSS experience is very strongly preferred. Experience with LTSS provider contracting and credentialing is a huge plus. You must have very strong verbal and written communication skills. Previous Medicaid or LTSS claims experience is helpful. Strong attention to detail is very important in this role.