Network Management Rep (US) - Georgia

Elevance Health • Columbus, GA

406d • Hybrid

About The Position

The Network Management Representative at Elevance Health serves as a vital link between the provider community and the company, addressing complex provider issues and ensuring high levels of provider satisfaction. This hybrid role involves researching and resolving provider disputes, coordinating claims resolution, and assisting with policy interpretation, all while maintaining effective communication with internal departments and providers.

Requirements

• Requires a H.S. diploma or equivalent and a minimum of 3 years of customer service experience; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

• Strong oral, written and interpersonal communication skills.
• Problem-solving skills.
• Facilitation skills.
• Analytical skills.

Responsibilities

• Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction.
• Researches and resolves complex provider issues and appeals for prompt resolution.
• Coordinates prompt claims resolution through direct contact with providers and claims department.
• May perform periodic provider on-site visits.
• Provides assistance with policy interpretation.
• Researches, analyzes and recommends resolution of provider disputes, issues with billing, and other practices.
• Assists providers with provider demographic changes as appropriate.
• Responds to provider issues related to billing, pricing, policy, systems and reimbursements.
• Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
• Determines if providers were paid according to contracted terms.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical benefits
• Dental benefits
• Vision benefits
• Short and long term disability benefits
• 401(k) with matching
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED
• Number of Employees: 11-50 employees