Provider Relationship Account Manager

Elevance Health

2d • Hybrid

About The Position

JR177060 Provider Relationship Account Manager Responsible for providing quality, accessible and comprehensive service to the company's provider community in Texas. Location: Hybrid 1: This role requires associates to be in-office 1 day 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. 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. How will you make an impact: Develops and maintains positive provider relationships with the provider community by regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues. Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention; researches, analyzes, and coordinates prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners. Collaborates within a cohort of internal matrix partners to triage issues and submit work requests. Generally, it is assigned to a portfolio of providers within a defined cohort. Coordinates Joint Operation Committees (JOC) of provider groups, driving the meetings in the discussion of issues and changes. May assist Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues. Coordinates communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns. Conducts proactive outreach to support the understanding of managed care policies and procedures, as well as on a variety of initiatives and programs. Participates in external Provider Townhalls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA). 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
• minimum of 3 years of customer service experience including 2 years of experience in a healthcare or provider environment
• or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

• Ability to travel to worksites and other locations as needed.
• Candidates should reside within a commutable distance to one of our Pulse locations in Texas.

Responsibilities

• Develops and maintains positive provider relationships with the provider community by regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.
• Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention; researches, analyzes, and coordinates prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners.
• Collaborates within a cohort of internal matrix partners to triage issues and submit work requests.
• Coordinates Joint Operation Committees (JOC) of provider groups, driving the meetings in the discussion of issues and changes.
• May assist Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues.
• Coordinates communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.
• Conducts proactive outreach to support the understanding of managed care policies and procedures, as well as on a variety of initiatives and programs.
• Participates in external Provider Townhalls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA).
• 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

• 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: Mid Level
• Number of Employees: 5,001-10,000 employees