Provider Relationship Account Consultant

Elevance Health•Woburn, MA

8d•Hybrid

About The Position

The Provider Relationship Account Consultant is responsible for providing quality, accessible and comprehensive service to the company's provider community. This role requires associates to be in-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 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 an accommodation is granted as required by law.

Requirements

Requires a bachelor’s degree
A minimum of 2 years of customer service experience
1 year of experience in a healthcare or provider environment
Any combination of education and experience, which would provide an equivalent background.
Strong proficiency in Microsoft Excel and Microsoft Word.
Excellent organizational and time management skills with the ability to prioritize multiple tasks and meet deadlines.
Strong attention to detail and accuracy.
Effective written and verbal communication skills.
Ability to analyze data, identify trends, and present findings clearly.
Ability to work independently and collaboratively in a team environment.
Strong problem-solving and critical-thinking skills.

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 provider utilization patterns.
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.