Provider Network Manager Senior

3 weeks ago


Topeka, Kansas, United States Elevance Health Full time
Job Title: Provider Network Manager Sr

At Elevance Health, we are seeking a highly skilled Provider Network Manager Sr to join our team. This role is responsible for developing and maintaining positive provider relationships with the provider community.

Key Responsibilities:
  • Coordinate non-negotiated contracts for new and existing providers as needed.
  • Function as a high-level technical resource to resolve or facilitate complex provider issues.
  • Provide assistance regarding education, contract questions, and non-routine claim issues.
  • Coordinate communications process 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 department.
  • Identify and report on provider utilization patterns that have 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:
  • A Bachelor's degree and a minimum of 5 years of customer service experience, including 2 years of experience as a Network Management Rep.
  • Ability to travel to worksite and other locations as necessary.
Work Environment:

This role will primarily work from home, with occasional on-site visits. The candidate must be located within 50 miles of the Topeka KS pulse point.

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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