MUST LIVE IN MICHIGAN
Responsible for various levels of activities supporting the recruitment, credentialing, and contracting process for potential and current Beacon providers. Responsibilities may range from maintenance support, provider education and communication with internal customers and Beacon providers, to reviewing provider files/programs and monitoring program compliance with applicable standards and regulations. Responsible for phone coverage. Provides internal support and follow-through in completion of the Provider Relations functions. Supports the local provider relations staff, including provider relations managers by providing research, problem resolution, administrative support, and follow-up on a variety of provider issues that may arise. Coordinates activities with other internal Beacon departments to provide optimal customer service to network providers and internal customers. Special projects and other duties as assigned.
Duties and Responsibilities
- Answers practitioners’/facility recruitment questions regarding Beacon policies and procedures, contracting requirements, and claims issues. Participate in responding to provider inquiries and problems.
- Provides follow up with practitioners and facilities for the return of completed credentialing and re-credentialing applications and contract documents. Verifies claims and application information with providers to update database. Process letters of resignation and may initiate disenrollment’s. Responds to provider requests for credentialing information.
- Provides assistance in compilation and mailing of provider recruitment mailings, general information and educational materials to network practitioners as required. Assists Provider Relations Managers with research to identify new providers for recruitment into the Beacon provider network. Initiates written requests to providers for credentialing information. Responsible for the coordination and implementation of activities necessary for the identification, review and selection of mental health and substance abuse treatment providers in support of Beacon Network Development.
- Performs research and problem resolution on issues related to provider complaints, claims reported to have been processed incorrectly, coordinating credentialing paperwork, provider communications or verification of information as requested. Assists Provider Relations Managers with report requests for network management purposes. Reviews/analyzes provider information through database queries. Review denial reports, weekly approval disenrollment grids and research information regarding this provider and the area(s) served. Meet with Provider Relations Managers and Director, Provider Relations staff, and Service Center staff to present information discuss plans of action to avoid disenrollment of key providers. Researches files and databases to address provider questions. Analyze beneficiary and provider demographics and generate proposed network configuration for review and incorporation into formal master plans produces by the Network Development Unit. Participate in the analysis and monitoring of provider utilization and performance data to ensure appropriate utilization for network providers and identify needs for network modifications as well as for initial and ongoing network configurations. Resolve customer/member/provider claims issues through investigation and problem solving. Follow-up on inquiries as needed, referring problems to other appropriate Beacon personnel as identified. Reviews/analyzes providers’ status through database queries. Researches files and databases to address provider questions. Prepares and disseminates reports.
- Obtain, process, manage and maintain both hard-copy and computer-based provider information necessary for network development and maintenance activities. Participates in the maintenance for files within a national database of potential and existing network providers. Attend all staff meetings, team conferences and in-service as directed. Maintain daily logs for future reference and analysis as well as document inquiries and complaints appropriately in MHS, Phoenix and Prism. Enter data accurately and timely into systems. Perform routine clerical functions including filing, copying, faxing, typing and record retrieval.
- Works closely with regional Network Operations team to ensure seamless customer service to providers. Interface with MSR, Care Managers and Claims staff to give information about provider contract/credentialing status to facilitate claims payment and referrals. Interface with external and internal customers to ensure optimal efficiency of service. Address concerns of dissatisfied and/or angry customers/members/providers in a diplomatic manner. Respond to customer inquiries professionally and efficiently. Assist in day-to-day departmental activities including phone coverage and file maintenance.
- Apply Beacon policies and procedures consistently. Maintain confidentiality of Clients, Business Records and Reports. Maintain ethical and professional standards. Maintain individual productivity and performance standards. Meet Departmental expectations, accuracy, productivity, and performance standards. Support Beacon in achieving Mission Statement. Adhere to the components of the Compliance Program. Ensure that job tasks are performed in a legal and ethical manner. Actively assess work area for non-compliance issues and notify supervisor or call Ethics Hotline. Adhere to compliance training requirements and understand that training is required condition of employment. Complete tasks accurately and within required timeframes.
Minimum Entry Level Qualifications
- This position requires a Bachelors’ Degree in a Human Services field, equivalent bachelor’s degree or equivalent work experience in a behavioral health or managed care environment in lieu of a Bachelor’s degree.
Years and Type of Relevant Work Experience:
- At least three years of experience in customer service, claims, auditing or provider relations in the behavioral health or managed care setting is required. Knowledge of and experience in provider benefits administration/health care setting. Knowledge of and experience with providers and provider network. Excellent verbal and written communication skills. Have a professional bearing and be able to speak comfortably with physicians, senior facility administrator and mental health professionals. Have strong problem-solving skills. Position requires some travel.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.