Provider Experience Manager
Elevance Health

Job Info

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Locations: Mason OH, Columbus OH, Seven Hills OH, Cincinnati OH

Hours: Monday - Friday

Travel: Hybrid (1-2 days per week)

Position Overview:

Responsible for providing quality, accessible and comprehensive service to the company's provider community. Develops and maintains positive provider relationships with the provider community by regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.

How You Will Make an Impact:

• Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention; researches, analyzes, and coordinates prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners
  
• Collaborates within a cohort of internal matrix partners to triage issues and submit work requests
  
• Generally, is assigned to a portfolio of providers within a defined cohort
  
• Coordinates Joint Operation Committees (JOC) of provider groups, driving the meetings in the discussion of issues and changes
  
• May assist Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues
  
• Coordinates communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns
  
• Conducts proactive outreach to support the understanding of managed care policies and procedures, as well as on a variety of initiatives and programs
  
• Participates in external Provider Townhalls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA)
  
• Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery
  
• Research issues that may impact future provider contract negotiations or jeopardize network retention
  

Required Qualifications:

• Requires a bachelor's degree; minimum of 3 years of customer service experience including 2 years of experience in a healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background.
  

Preferred Qualifications:

• Provider relations experience strongly preferred
  
• Provider contract language preferred
  
• Ohio Medicaid experience strongly preferred
  
• Public speaking experience preferred
  
• Medicaid professional and facility Claims/billing knowledge preferred
  

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