Provider Network Manager Sr

2 weeks ago


Topeka, Kansas, United States Elevance Health Full time
Job Summary:

Develops and maintains positive provider relationships with the provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues. Serving as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution.

Key Responsibilities:

  • Coordinates non-negotiated contracts for new and existing providers as needed.
  • Functions as a high-level technical resource to resolve or facilitate complex provider issues. Coordinates Joint Operation Committees (JOC) of larger provider groups, driving the meetings in the discussion of issues and changes.
  • Provides assistance regarding education, contract questions, and non-routine claim issues.
  • Coordinates communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.
  • Coordinates prompt claims resolution through direct contact with providers, claims, pricing, and medical management department. Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
  • Tracks and conducts provider refresher training.
  • Researches issues that may impact future provider negotiations or jeopardize network retention.
Requirements:

  • A Bachelor's degree and a minimum of 5 years of customer service experience, including 2 years of experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.
  • Travels to worksite and other locations as necessary.


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