Provider Network Manager Sr
Elevance Health

Job Info

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Location: Primarily work from home , must go on-site 1 time per week . Candidate must be located within 50 miles of the Topeka KS pulse point.

Shift: Monday-Friday 8:30am-5:00pm CST

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.

Primary Duties:

• 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.

Requirements:

• 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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