Provider Relationship Account Mgr Sr

Elevance Health•Indianapolis, IN

43d•Hybrid

About The Position

Location: Indianapolis, Indiana 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. 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 Mgr Sr is responsible for providing quality, accessible and comprehensive service to the company's provider community. Develops and maintains positive provider relationships with 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.

Requirements

Bachelor's degree
a minimum of 5 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.

Responsibilities

Serve as a knowledge and resource expert regarding complex provider issues impacting provider satisfaction; research, analyzes, and coordinates prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners.
Collaborate within a cohort of internal matrix partners to triage issues and submit work requests. Generally, is assigned to a portfolio of providers within a defined cohort.
Coordinate Joint Operation Committees (JOC) of provider groups, driving the meetings in the discussion of issues and changes.
May assist with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues.
Coordinate communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
Conduct proactive outreach to support the understanding of managed care policies and procedures, as well as on a variety of initiatives and programs.
Identify and report on provider utilization patterns which have a direct impact on the quality-of-service delivery.
Organize and execute external Provider Town Halls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA).
Research complex issues that may impact future provider contract negotiations or jeopardize network retention.
May be responsible for monitoring department metrics, provider assignments and oversight of daily activities and provide feedback to manager on performance management, day-to-day training, guidance, and workflow of Provider Relationship Account Mgt. Consultants/Managers.
Travel to worksite and other locations as necessary.