Network Education Rep Sr (US)
Elevance Health

Job Info

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Network Education Representative Sr.

Location: Tampa FL. or Miami, Fl. This is a hybrid role with 1 - 2 days per week required in-office. Selected candidate must reside within 50 miles or one hour commute from a pulse point Elevance Health Location.

How you will make an impact:

• Supports and maintains current provider network through customer service including training, credentialing assistance, claims resolution and advocacy.
• Develops and provides a standard orientation package for newly contracted providers.
• Promotes technology and skills development to improve provider business practices.
• Provides/coordinates provider training for claims and billing procedures, contract compliance, medical management, and pharmacy issues.
• Promotes provider compliance with local/state/region/federal regulations through provider forums and training opportunities.
• Supports the contractual agreements with all providers to ensure compliance with local/state/federal regulations.
• Facilities provider network by recruiting necessary PCP, Specialist, Ancillary, and Hospital providers and assisting Network Support, Contracting, and Credentialing associates to credential and maintain accurate provider contract data.
• Provides leadership in the development, implementation and evaluation of provider operations, contracting and issue resolution strategies.
• Mentors, coaches and trains lower level staff.
• Reviews state and national programs, trends and literature regarding provider issues and recommend appropriate strategies.

Minimum Requirements:

• Requires a BA/BS degree and a minimum of 4 years experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Long term care, managed care preferred.
• Prior leadership experience preferred.
• Experience with Medicaid products preferred.
• Avality training preferred.
• Bilingual preferred.

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