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Network Relations Consultant
2 months ago
Job Summary:
The Network Relations Consultant plays a critical role in developing and maintaining positive relationships with healthcare providers. This position requires strong communication and problem-solving skills to ensure seamless interactions between Elevance Health and its network of providers.
Key Responsibilities:
- Develop and implement strategies to improve provider satisfaction and engagement.
- Collaborate with internal stakeholders to resolve complex provider issues and appeals.
- Conduct regular on-site visits and communicate administrative and programmatic changes to providers.
- Facilitate education and training sessions to support provider understanding of managed care policies and procedures.
- Research and analyze data to identify trends and areas for improvement in provider relations.
- Participate in Joint Operation Committees (JOCs) with larger provider groups to foster collaboration and mutual understanding.
- Coordinate communication processes related to administrative and medical policy, reimbursement, and provider utilization patterns.
- Develop and distribute provider relations materials, including training programs and educational resources.
- Provide exceptional customer service to Elevance Health's provider community, addressing education, contract questions, and non-routine claim issues.
- Coordinate prompt claims resolution through direct contact with providers, claims, pricing, and medical management departments.
- Track and conduct provider refresher training to ensure ongoing education and support.
- Research issues that may impact future provider negotiations or jeopardize network retention.
Requirements:
- Bachelor's Degree and a minimum of 3 years of customer service experience, including 2 years as a Network Management Representative.
- Experience with Medi-Cal and Medicare (D-SNP) managed care plans is preferred.
What We Offer:
Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution. We are committed to ensuring equal pay opportunities for equal work, regardless of gender, race, or any other protected category.
Work Environment:
Elevance Health operates in a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location at least once per week. Candidates must reside within 50 miles or a 1-hour commute of a relevant Elevance Health location.
Equal Employment Opportunity:
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 protected status.
