Network Relations Consult (US)-8
Network Relations Consult (US)-8
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Job Description
Anticipated End Date:
Position Title:
Network Relations Consult (US)8Job Description:
Network Relations Consultant
Location:This fieldbased role enables associates to primarily operate in the field traveling to client sites or designated locations as their role requires with occasional office attendance for meetings or training. This approach ensures flexibility responsiveness to client needs and direct handson engagement.
Schedule: This position will work on the hours from 8:00 am5:00 pm Monday thru Friday. Additional hours or days may be required based on operational needs.
The Network Relations Consultant is responsible for develops and maintains positive provider relationships with provider community by regular onsite 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.
How you will make an impact
Primary duties include but are not limited to:
- Coordinating nonnegotiated contracts for new and existing providers as needed.
- Researches analyzes and recommends resolution for contract dispute nonroutine 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 companys provider community.
- Provide assistance regarding education contract questions and nonroutine 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 Requirement:
- Requires a Bachelors 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.
Job Level:
NonManagement ExemptWorkshift:
1st Shift (United States of America)Job Family:
PND > Provider Relationship Account MgmtPlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.
Who We Are
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.
How We Work
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 marketcompetitive 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/memberfacing roles to become vaccinated against COVID19 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 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.
Employment Type
Full-Time
