Network Relations Consultant

Network Relations Consultant

Network Relations Consultant

Location : Hybrid1 : This role requires associates be in the 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.

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 Network Relations Consultant 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.

How you will make an impact :

• 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.

Minimum Requirements :

Preferred Skills, Capabilities, and Experiences :

Job Level : Non-Management Exempt

Workshift : Not specified

Job Family : PND >

Provider Relationship Account Mgmt

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient / member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.