LTSS Network Relations Consultant, West Iowa at Elevance Health

Carroll, 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
Residency in Iowa required
Ability to travel within the west region of Iowa to worksite and other locations as necessary
Must be within reasonable commuting distance from Carroll, Iowa and surrounding counties (unless accommodation granted)

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 resolves provider issues
Serves as a knowledge and resource expert on provider issues impacting 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 on administrative and medical policy, reimbursement, and provider utilization patterns
Conducts seminars to support understanding of managed care policies and procedures
Identifies network access deficiencies and develops recruitment and contracting strategies
Coordinates and conducts provider training, including developing and distributing provider relations materials
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 impacting 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 ManagementNetwork ManagementLTSSClaims ResolutionBillingManaged CareProvider EducationDispute ResolutionUtilization ManagementCommunicationOn-site VisitsAppeals Processing

Questions & Answers

Common questions about this position

What is the work arrangement for this role?

This is a field-based role requiring primarily on-site visits to client sites or designated locations in West Iowa, with occasional office attendance for meetings or training. Candidates must reside in Iowa and be within a reasonable commuting distance from Carroll, Iowa and surrounding counties.

What are the minimum education and experience requirements?

A Bachelor's degree and a minimum of 3 years of customer service experience are required.

What salary or compensation does this position offer?

This information is not specified in the job description.

What are the main responsibilities of the LTSS Network Relations Consultant?

The role involves developing and maintaining provider relationships through on-site visits, resolving complex provider issues, coordinating communications on policies and reimbursement, conducting training and seminars, and identifying network needs.

What makes a candidate a strong fit for this position?

Strong candidates will have a Bachelor's degree, at least 3 years of customer service experience, and the ability to reside in Iowa with willingness to travel regularly in the West Iowa region for field-based work.

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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