Elevance Health
LTSSNetworkRelationsConsultant
“LTSS Network Relations Consultant at Elevance Health. Skills: Provider Relations, Network Relations, Issue Resolution. Develop and maintain positive provider relationships. Communicate administrative and programmatic changes”
What You'll Achieve.
Prompt resolution of provider issues; Provider satisfaction; Network retention
Industry & Context.
Issue Resolution; Problem Solving
Candidates must reside in Dayton or Cincinnati metro area, Travel to client sites or designated locations
What They're Looking For.
Must Have
Bachelor's degree, 3 years of customer service experience, 2 years experience as a Network Management
Nice to Have
Experience working with LTSS and/or Waiver populations, communication skills (written and verbal), especially with communicating with the various customers and support teams, Healthcare insurance experience, Experience in claims service operations, Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly
What You'll Do.
Develop and maintain positive provider relationships
Communicate administrative and programmatic changes
Facilitate education and resolution of provider issues
Serve as knowledge and resource expert
Research and resolve complex provider issues and appeals
Coordinate non-negotiated contracts
analyze and recommend resolution for contract dispute
Coordinate communication process on administrative and medical policy
Conduct seminars to support understanding of managed care policies
Identify network access and deficiencies
Develop recruitment and contracting strategies
Coordinate and conduct provider training
Provide assistance regarding education and contract questions
Coordinate prompt claims resolution
Identify and report on provider utilization patterns
Track and conduct provider refresher training
Research issues that may impact future provider negotiations
How You'll Work.
Team & Collaboration
Work with claims, pricing and medical management department
Communication Scope
written communication skills; verbal communication skills
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