Provider Relationship Account Consultant

Elevance Health•Knoxville, TN

3d•Onsite

About The Position

The Provider Relationship Account Consultant is responsible for providing quality, accessible and comprehensive service to the company's provider community. This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Alternate locations may be considered if candidates reside within a commuting distance from an office. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

Requirements

Requires a bachelor’s degree; a minimum of 2 years of customer service experience including 1 year of experience in a healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background.
Travels to worksite and other locations as necessary.

Nice To Haves

Provider Relations Experience – managing health systems, ancillary providers, and physician groups strongly preferred.
Experienced in developing PowerPoint presentations and delivering presentations to large groups, providers, leaders, etc.
Knowledge of Medicaid and/or Medicare agreements.
Managed Care/Health Insurance industry experience.
Facets knowledge (particularly claims).
Claims resolution experience is strongly preferred.
Strong knowledge/understanding of claims reimbursement in general.
Salesforce experience.
Experience in dealing with adversity, particularly difficult people and situations.

Responsibilities

Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and/or face-to-face outreach, by communicating administrative and programmatic changes, facilitating provider education and the resolution of provider issues.
Collaborates with internal matrix partners to triage issues and submit work requests.
Generally assigned to a portfolio of providers within a defined cohort.
Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners.
Coordinates communication process on such issues as administrative and medical policy, reimbursement, and health plan updates.
Conducts routine outreach to support the understanding of managed care policies and procedures, as well as outreach on a variety of initiatives and programs.
Coordinates and conducts provider training including developing and distributing provider relations materials.
May assist with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education and non-routine claim issues.
May coordinate Provider Manual updates/maintenance.
Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery.
Research issues that may impact future provider contract negotiations or jeopardize network retention.