Provider Relationship Account Mgr Sr at Elevance Health

Indianapolis, Indiana, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Bachelor’s degree
A minimum of 5 years of customer service experience
Including 2 years of experience in a healthcare or provider environment
Or any combination of education and experience, which would provide an equivalent background
Must be within a reasonable commuting distance from Indianapolis, Indiana (or alternate locations considered), with in-office presence 1-2 days per week
Ability to travel to worksite and other locations as necessary

Responsibilities

Develop and maintain positive provider relationships through regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and resolution of provider issues
Serve as a knowledge and resource expert regarding complex provider issues impacting provider satisfaction; research, analyze, and coordinate prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners
Collaborate within a cohort of internal matrix partners to triage issues and submit work requests; generally assigned to a portfolio of providers within a defined cohort
Coordinate Joint Operation Committees (JOC) of provider groups, driving meetings in the discussion of issues and changes
Assist with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring, education, contract questions, and non-routine claim issues
Coordinate communications process on issues such as administrative and medical policy, reimbursement, and provider utilization patterns
Conduct proactive outreach to support understanding of managed care policies and procedures, as well as on a variety of initiatives and programs
Identify and report on provider utilization patterns which have a direct impact on quality-of-service delivery
Organize and execute external Provider Town Halls/Seminars and attend State Association conferences (e.g., MGMA, AFP, AAP, HFMA)
Research complex issues that may impact future provider contract negotiations or jeopardize network retention
May monitor department metrics, provider assignments, and oversight of daily activities; provide feedback to manager on performance management, day-to-day training, guidance, and workflow of Provider Relationship Account Mgt. Consultants/Managers

Skills

Key technologies and capabilities for this role

Provider RelationsStakeholder ManagementIssue ResolutionAppeals ManagementJoint Operation CommitteesProvider Satisfaction SurveysContract ManagementClaims ProcessingMatrix CollaborationCommunication Coordination

Questions & Answers

Common questions about this position

What is the work arrangement for this role?

This role requires associates to be in-office 1-2 days per week in Indianapolis, Indiana, while providing flexibility for virtual work. Candidates must be within a reasonable commuting distance from the posting location, unless an accommodation is granted.

What are the minimum education and experience requirements?

A Bachelor’s degree and a minimum of 5 years of customer service experience, including 2 years in a relevant role, are required.

Is travel required for this position?

Yes, travel to worksite and other locations is necessary as required.

What does the role involve in terms of provider relationships?

The role focuses on developing and maintaining positive provider relationships through regular on-site and/or virtual visits, resolving complex issues, coordinating meetings, and conducting outreach on policies and programs.

What salary or compensation does this position offer?

This information is not specified in the job description.

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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