Network Relations Consult Sr (US)-1
Elevance Health

Job Info

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Network Relations Consult Sr.

Location: This position is in Miami, FL. This is a field position requiring 3-4 times a week in the field. The selected candidate must reside within 50 miles or one hour commute from a pulse point Elevance Health Location.

How you will make an impact:

• 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.
• Serving as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution.
• May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
• Functions as a high level technical resource to resolve or facilitate complex provider issues.
• Coordinates Joint Operation Committees (JOC) of larger provider groups, driving the meetings in the discussion of issues and changes.
• 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:

• Requires a Bachelor's degree and a minimum of 5 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.

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