Provider Relationship Account Consultant

Elevance Health•Cerritos, CA

1d•Hybrid

About The Position

The Provider Relationship Account Consultant develops and maintains positive provider relationships within the provider community. This field-based role involves regular on-site visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues. The consultant acts as a knowledge and resource expert, researching and resolving complex provider issues and appeals, and may coordinate non-negotiated contracts. Responsibilities also include analyzing and recommending resolutions for contract disputes, non-routine claim issues, and billing questions. The role involves coordinating communication on administrative and medical policy, reimbursement, and provider utilization patterns, as well as conducting seminars and provider training. The consultant identifies network access and deficiencies to develop recruitment and contracting strategies, and ensures quality, accessible, and comprehensive service to the company's provider community. Occasional office attendance for meetings and training is required.

Requirements

Requires a Bachelor's degree and a minimum of 3 years of customer service experience including 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.
Travels to worksite and other locations as necessary.

Responsibilities

Develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.
Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution.
May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
May participation in Joint Operation Committees (JOC) of larger provider groups.
Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
Conducts seminars to support the understanding of managed care policies and procedures.
Identifies network access and deficiencies and develops recruitment and contracting strategies.
Coordinates and conducts provider training including developing and distributing provider relations materials.
Responsible for providing quality, accessible and comprehensive service to the company's provider community.
Provide assistance regarding education, contract questions and non-routine claim issues.
Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department.
Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
Tracks and conduct provider refresher training.
Researches issues that may impact future provider negotiations or jeopardize network retention.