Provider Network Manager
Elevance Health

Job Info

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Location: N17W24222 Riverwood Dr., Ste 300 Waukesha, WI

Elevance Health supports a hybrid workplace model (virtual and office) with PulsePoint sites used for collaboration, community, and connection, with the minimum in-office commitment being 1-3 days in an office per week.

Candidates must reside within 50 miles or 1-hour commute each way of the above Elevance Health location.

Develops the provider network through contract negotiations (language and rates), relationship development, and servicing.

PRIMARY DUTIES:

• Primary focus of this role is contracting and negotiating contract terms.
• Typically works with less-complex to complex providers.
• Providers may include, but are not limited to, smaller institutional providers, professional providers with more complex contracts, medical groups, physician groups, small hospitals that are not part of a health system, ancillary providers, providers in areas with increased competition or where greater provider education around managed care concepts is required.
• Contracts may involve non-standard arrangements that require a moderate level of negotiation skills.
• Value based concepts understanding.
• Fee schedules can be customized.
• Works with increased independence and requires increased use of judgment and discretion.
• May work on cross-functional projects requiring collaboration with other key areas.
• Serves as a communication link between professional providers and the company.
• Assists in preparing financial projections and conducting analysis as required.

Minimum Requirements:

Requires a BA/BS degree and a minimum of 3 years' experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experience:

• Excellent Microsoft, Excel, and PowerPoint skills.
• Great communication and organization skills.
• Ability to speak with providers and office staff.
• Preferred knowledge of claims, health insurance industry payment methods.
• Travels to worksite and other locations, as necessary.

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