Network Management Rep

1 month ago

Columbus, United States Elevance Health Full time

Please note: This is a hybrid role where the successful hire will be within 50 miles of one of our company offices/Pulse Point locations and may get asked to work in office 1-2x a week. The Network Management Rep - Georgia provides comprehensive services to the provider community through researching more complex provider issues. Primary duties may include, but are not limited to: 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. May perform periodic provider on-site visits. 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. Position requirements: Requires a H.S. diploma or equivalent 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, qualifications, and experiences: Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred. 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 business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

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