Network Relations Consultant Sr

2 weeks ago

Sacramento, California, United States Elevance Health Full time
About the Role

We are seeking a highly skilled Network Relations Consultant Sr to join our team at Elevance Health. As a key member of our organization, you will play a critical role in initiating, negotiating, and executing contracts with HCBS providers.

Key Responsibilities
  • Communicate contract terms, payment structures, and reimbursement rates to providers and maintain positive relationships.
  • Maintain and track contracts and documentation within a tracking system.
  • Assist with identifying and recruiting providers based on network composition and needs.
  • Serve as a knowledge expert regarding HCBS provider contracting.
  • Negotiate and execute contracts for new and existing providers.
  • Function as a high-level technical resource to resolve or facilitate complex provider issues.
  • Participate in Joint Operation Committees (JOC) of larger provider groups and participate in discussions of issues and changes.
  • Provide assistance regarding education, contract questions, and non-routine claim issues.
  • Coordinate communications on administrative and medical policy, reimbursement, and provider utilization patterns.
  • Coordinate prompt claims resolution through direct contact with providers, claims, pricing, and medical management department.
  • Identify and report on provider utilization patterns that have a direct impact on the quality of service delivery.
  • Track and conduct provider training.
  • Research issues that may impact future provider negotiations or jeopardize network retention.
Requirements
  • Requires a Bachelor's degree and a minimum of 5 years of customer service experience, including 2 years' experience as a Network Management Rep.
  • Preferred qualifications include provider contracting skills, contract preparation and implementation, financial analysis, and rate proposal development.
  • Experience with HCBS providers, contract negotiation and execution, and provider recruitment is highly desirable.
About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities. 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.

What We Offer
  • A range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs.
  • A comprehensive benefits package, including medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.

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