Provider Relationship Account Consultant

Elevance Health • Latham, NY

9d • Hybrid

About The Position

Provider Relationship Account Consultant Location: 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. Ideal candidates will be able to report to our Pulse Point location in Latham, NY. 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 Provider Relationship Account Consultant will be responsible for providing quality, accessible and comprehensive service to the company's provider community. A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care. How you will make an impact: 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.

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.

Nice To Haves

• Provider customer service experience preferred.
• Strong communication (verbal and written) skills to resolve workplace/client conflicts ensuring all parties feel heard and respected preferred.
• Working knowledge of Microsoft Excel and Word preferred.
• Experience with claims/provider systems (i.e. Facets, WGS, and/or SPS) preferred.

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.

Benefits

• Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• 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.
• Paid holidays
• Paid Time Off

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees