LTSS Network Relations Consultant, West Iowa at Elevance Health

Carroll, Iowa, United States

Apply Now

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

Provider Relations

Contract Management

Network Management

LTSS

Claims Resolution

Billing

Managed Care

Provider Education

Dispute Resolution

Utilization Management

Communication

On-site Visits

Appeals Processing

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.

Land your dream remote job 3x faster with AI

Try Jobo Free