Provider Relationship Account Manager at Elevance Health

Las Vegas, Nevada, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Behavioral Health, Mental HealthIndustries

Requirements

Bachelor’s degree
Minimum of 3 years of customer service experience
Minimum of 2 years of experience in a healthcare or provider environment (or any combination of education and experience providing an equivalent background)
Ability to travel to worksite and other locations as necessary
Reside within a reasonable commuting distance from the posting location (9133 W. Russell Rd, Las Vegas, NV) unless an accommodation is granted as required by law

Responsibilities

Develops and maintains positive provider relationships with the provider community through regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues
Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention; researches, analyzes, and coordinates prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners
Collaborates within a cohort of internal matrix partners to triage issues and submit work requests
Assigned to a portfolio of providers within a defined cohort; coordinates Joint Operation Committees (JOC) of provider groups, driving the meetings in the discussion of issues and changes
Assists with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring, education, contract questions, and non-routine claim issues
Coordinates communications process on issues such as administrative and medical policy, reimbursement, and provider utilization patterns
Conducts proactive outreach to support the understanding of managed care policies and procedures, as well as on a variety of initiatives and programs
Participates in external Provider Townhalls/Seminars and attends State Association conferences (e.g., MGMA, AFP, AAP, HFMA)
Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery
Researches issues that may impact future provider contract negotiations or jeopardize network retention

Skills

Key technologies and capabilities for this role

Provider RelationsAccount ManagementStakeholder CommunicationIssue ResolutionNetwork ManagementHealthcare AdministrationProvider EducationRelationship BuildingAnalyticsVirtual Collaboration

Questions & Answers

Common questions about this position

What is the work arrangement for this role?

This is a hybrid role requiring associates to be in-office 1-2 days per week at 9133 W. Russell Rd, Las Vegas, NV, to foster collaboration while providing flexibility. Alternate locations may be considered if candidates reside within commuting distance from an office, but those not within reasonable commuting distance will not be considered unless an accommodation is granted.

What are the main responsibilities of the Provider Relationship Account Manager?

The role involves developing and maintaining provider relationships through visits and communications, resolving complex provider issues, collaborating with internal partners, coordinating Joint Operation Committees, and conducting outreach on policies and programs.

What salary or compensation does this position offer?

This information is not specified in the job description.

What is the company culture like at Carelon Behavioral Health?

The company emphasizes being part of an extraordinary team, building possibilities, making an extraordinary impact, and fostering collaboration and connectivity through hybrid work while supporting work-life balance.

What makes a strong candidate for this Provider Relationship Account Manager role?

Strong candidates should have experience in provider relations, issue resolution, collaboration with matrixed partners, and knowledge of managed care policies, with the ability to conduct outreach and coordinate committees.

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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