Network Relations Consultant

4 days ago

Olathe, Kansas, United States Elevance Health Full time
Job Title: Network Relations Consultant

Job Summary:

We are seeking a highly skilled Network Relations Consultant to join our team at Elevance Health. As a key member of our organization, you will be responsible for developing and maintaining positive provider relationships with the Kansas LTSS provider community.

Key Responsibilities:

  • Develop and maintain positive provider relationships through regular on-site visits, communication of administrative and programmatic changes, and facilitation of education and issue resolution.
  • Serve as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researching and resolving complex provider issues and appeals for prompt resolution.
  • Coordinate non-negotiated contracts for new and existing providers as needed.
  • Research, analyze, and recommend resolution for contract disputes, non-routine claim issues, billing questions, and other practices.
  • Participate in Joint Operation Committees (JOC) of larger provider groups.
  • Coordinate communication processes on issues such as 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 and develop recruitment and contracting strategies.
  • Coordinate and conduct provider training, including developing and distributing provider relations materials.
  • Provide quality, accessible, and comprehensive service to the company's provider community.
  • Assist with education, contract questions, and non-routine claim issues.
  • Coordinate communications processes on issues such as administrative and medical policy, reimbursement, and provider utilization patterns.
  • Coordinate prompt claims resolution through direct contact with providers, claims, pricing, and medical management departments.
  • Identify and report on provider utilization patterns with a direct impact on the quality of service delivery.
  • Track and conduct provider refresher training.
  • 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 of experience as a Network Management Rep.
  • Any combination of education and experience that would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

  • Previous experience providing resolution of issues, including but not limited to: enrollment/eligibility determinations, credentialing issues, authorization issues, and claims processing/payment disputes.

About Elevance Health:

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.

Our Culture:

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, and 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.

Benefits:

We offer a range of market-competitive total rewards, including 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.

Hybrid Workforce Strategy:

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.

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 status or condition protected by applicable federal, state, or local laws.

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