Network Relations Consultant

18 hours ago

Tampa FL USA, United States Elevance Health Full time
Job Title: Network Relations Consultant

We are seeking a skilled Network Relations Consultant to join our team at Elevance Health. As a Network Relations Consultant, you will play a critical role in developing and maintaining positive relationships with our provider community.

Key Responsibilities:
  • Develop and maintain strong relationships with providers through regular on-site visits, effective communication, and issue resolution.
  • Serve as a knowledge expert on provider issues, researching and resolving complex issues to ensure prompt resolution.
  • Coordinate non-negotiated contracts for new and existing providers as needed.
  • Research, analyze, and recommend resolutions for contract disputes, non-routine claim issues, and billing questions.
  • Participate in Joint Operation Committees (JOC) of larger provider groups.
  • Coordinate communication processes on administrative and medical policy, reimbursement, and provider utilization patterns.
  • Conduct seminars to support understanding of managed care policies and procedures.
  • Identify network access and deficiencies, developing recruitment and contracting strategies.
  • Coordinate and conduct provider training, including developing and distributing provider relations materials.
  • Provide quality, accessible, and comprehensive service to our provider community.
  • Assist with education, contract questions, and non-routine claim issues.
  • Coordinate prompt claims resolution through direct contact with providers, claims, pricing, and medical management departments.
  • Identify and report on provider utilization patterns impacting quality-of-service delivery.
  • Track and conduct provider refresher training.
  • Research issues impacting future provider negotiations or jeopardizing network retention.
Requirements:
  • Bachelor's degree and a minimum of 3 years of customer service experience, including 2 years as a Network Management Rep.
  • Ability to travel to worksite and other locations as necessary.
Preferred Skills:
  • Long-term care experience.
  • Assisted living facilities experience.
  • Experience working with Medicaid providers.

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.

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