Senior Provider Network Manager

3 weeks ago


Topeka, Kansas, United States Elevance Health Full time

Job Summary:

Elevance Health is seeking a skilled Senior Provider Network Manager to join our team. As a key member of our network management team, you will be responsible for developing and maintaining positive provider relationships, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.

Key Responsibilities:

  • Develops and maintains positive provider relationships through regular on-site visits, communication, and education.
  • Serves as a knowledge and resource expert regarding complex provider issues, researching and resolving issues for prompt resolution.
  • 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 meetings and discussions on issues and changes.
  • Provides assistance regarding education, contract questions, and non-routine claim issues.
  • Coordinates communications process on 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 impacting quality of service delivery.
  • Tracks and conducts provider refresher training.
  • Researches issues impacting future provider negotiations or jeopardizing network retention.

Requirements:

A Bachelor's degree and a minimum of 5 years of customer service experience, including 2 years as a Network Management Rep, or any combination of education and experience providing an equivalent background.

What We Offer:

Elevance Health offers a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. We also offer medical, dental, vision, short and long-term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.

Work Environment:

Elevance Health operates in a Hybrid Workforce Strategy. 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.

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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