Provider Relationship Account Consultant
Provider Relationship Account Consultant
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$ 66608 - 104256
1 Vacancy
Job Description
Anticipated End Date:
Position Title:
Provider Relationship Account ConsultantJob Description:
Provider Relationship Account Consultant
Location: Woodland Hills Costa Mesa and Walnut Creek CA. This role requires associates be in the office 12 days per week fostering collaboration and connectivity while providing flexibility to support productivity and worklife balance. This approach combines structured office engagement with the autonomy of virtual work promoting a dynamic and adaptable workplace.
Carelon Behavioral Health Inc. is enthusiastically supporting the CYBHI Fee Schedule Fee Schedule program managed by the Department of Health Care Services (DHCS) as their dedicated ThirdParty Administrator. Our goal To improve the mental health services offered to Californias young students via this pivotal initiative.
Were expanding our team and eager to connect with professionals experienced in healthcare administration network management provider relations and program this program were aligning our goals with Governor Newsoms Kids Mental Health and the Children and Youth Behavioral Health Initiative (CYBHI). Were working closely with DHCS the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) to implement a multipayer fee schedule ensuring fair reimbursement for schoollinked providers offering designated outpatient mental health and substance use disorder services.
The Provider Relationship Account Consultant is responsible for providing quality accessible and comprehensive service to the companys provider in this program include Local Education Agencies County Offices of Education public Institutions of Higher Education Billing Vendors and Affiliated Providers.
How you will make an impact:
- Develop and maintain positive provider relationships with provider community via a mixture of email telephonic and/or facetoface outreach by communicating administrative and programmatic changes facilitating provider education and the resolution of provider issues.
- Collaborates with internal matrix partners to triage issues and submit work requests.
- Generally assigned to a portfolio of providers within a defined cohort.
- Researches analyzes and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners.
- Coordinates communication process on such issues as administrative and program policy reimbursement and provider utilization patterns.
- Conducts routine outreach to support the understanding of managed care policies and procedures as well as outreach on a variety of initiatives and programs.
- Coordinates and conducts provider training including developing and distributing provider relations materials.
- May assist with Annual Provider Satisfaction Surveys required corrective action plan implementation and monitoring education and nonroutine claim issues.
- May coordinate Provider Manual updates/maintenance.
- Identifies and reports on provider utilization patterns which have a direct impact on the qualityofservice delivery.
- Research issues that may impact future provider contract negotiations or jeopardize network retention.
Minimum Requirements:
- Requires a Bachelors degree; a minimum of 2 years of customer service experience including 1 year of experience in a Healthcare or Provider environment; or any combination of education and experience which would provide an equivalent background.
Preferred Skills Capabilities and Experiences:
- Experience working in the behavioral health field.
- Experience working in provider relations.
- Experience in education system.
- Experience with MediCal.
For candidates working in person or virtually in the below location(s) the salary* range for this specific position is $66608 to $104256
Locations: California
In addition to your salary Elevance Health offers benefits such as a comprehensive benefits package incentive and recognition programs equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate nondiscriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender race or any other category protected by federal state and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location work experience education and/or skill level. Even within the range the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned vested and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus commission benefits or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.
Job Level:
NonManagement ExemptWorkshift:
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.
Required Experience:
Contract
Employment Type
Full-Time
