LTSS Network Relations Consultant, Central Iowa at Elevance Health

Marshalltown, Iowa, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Bachelor's degree and a minimum of 3 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
Residency in Iowa is a requirement
Ability to travel within the central region of Iowa
Candidates must be within a reasonable commuting distance from the posting location(s) (Marshalltown, Iowa, and surrounding counties), unless an accommodation is granted as required by law

Responsibilities

Develops and maintains positive provider relationships with the provider community through regular on-site visits
Communicates administrative and programmatic changes to providers
Facilitates education and the resolution of provider issues
Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction
Researches and resolves complex provider issues and appeals for prompt resolution
May coordinate non-negotiated contracts for new and existing providers as needed
Researches, analyzes, and recommends resolution for contract disputes, non-routine claim issues, billing questions, and other practices
May participate in Joint Operation Committees (JOC) of larger provider groups
Coordinates communication process on issues such as administrative and medical policy, reimbursement, and provider utilization patterns
Conducts seminars to support the understanding of managed care policies and procedures
Identifies network access and deficiencies and develops recruitment and contracting strategies
Coordinates and conducts provider training, including developing and distributing provider relations materials
Provides quality, accessible, and comprehensive service to the company's provider community
Provides assistance regarding education, contract questions, and non-routine claim issues
Coordinates prompt claims resolution through direct contact with providers, claims, pricing, and medical management departments
Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery
Tracks and conducts provider refresher training
Researches issues that may impact future provider negotiations or jeopardize network retention

Skills

Key technologies and capabilities for this role

provider relationscontract managementclaims resolutionbillingmanaged carereimbursementutilization managementprovider educationdispute resolutionnetwork development

Questions & Answers

Common questions about this position

What is the work arrangement for this role?

This is a field-based role where associates primarily operate in the field, traveling to client sites or designated locations, with occasional office attendance for meetings or training. Candidates must be within a reasonable commuting distance from Marshalltown, Iowa, and surrounding counties, with Iowa residency required and ability to travel within the central region.

What are the minimum education and experience requirements?

The role requires a Bachelor's degree and a minimum of 3 years of experience.

What does the role involve in terms of provider relations?

The position develops and maintains positive provider relationships through regular on-site visits, communicates changes, facilitates education, resolves provider issues, and serves as a knowledge expert on provider satisfaction.

Is there a salary range listed for this position?

This information is not specified in the job description.

What should I include in my application to stand out?

Highlight your Bachelor's degree, at least 3 years of relevant experience, and skills in provider relations, issue resolution, communication, and travel willingness within central Iowa to demonstrate you meet the minimum requirements and can handle field-based responsibilities.

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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