Provider Relationship Account Consultant

Provider Relationship Account Consultant

Provider Relationship Account Consultant

Location : This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.

Please note that per our policy on hybrid work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Provider Relationship Account Consultant will be responsible for providing quality, accessible and comprehensive service to the companys provider community while leveraging data-driven insights to drive improved Payment Integrity outcomes.

How you will make an impact :

• Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and / or face-to-face outreach, by communicating administrative and programmatic changes, facilitating provider education and the resolution of provider issues.
• Collaborates with internal matrix partners to triage issues and submit work requests.
• Generally assigned to a portfolio of providers within a defined cohort.
• Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners while interpreting provider performance scorecards to identify root causes and recommend targeted interventions.
• Coordinates communication process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.
• Conducts routine outreach to support the understanding of managed care policies and procedures, as well as outreach on a variety of initiatives and programs : focused on reducing administrative waste, improving documentation accuracy, and supporting digital tool adoption, while tracking the impact of provider engagement on medical savings, recovery cycle times, and compliance metrics.
• Coordinates and conducts provider training including developing and distributing provider relations materials.
• May assist with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education and non-routine claim issues.
• May coordinate Provider Manual updates / maintenance.
• 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.

Minimum Requirements :

Preferred Skills, Capabilities and Experiences :

For candidates working in person or remotely in the below location(s), the salary

Locations : Illinois

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

Job Level : Non-Management Exempt

Workshift : 1st Shift (United States of America)

Job Family : PND >

Provider Relationship Account Mgmt

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient / member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.