Network Management Representative

Elevance Health • Atlanta, GA

5d • Hybrid

About The Position

Network Management Representative Location: Hybrid1: This role requires associates be in the office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Network Management Representative provides comprehensive services to the provider community through researching more complex provider issues. How you will make an impact: Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction. Researches and resolves the 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.

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, and analytical skills strongly preferred.
• Network Connect experience highly preferred.

Responsibilities

• Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction.
• Researches and resolves the 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

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees