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Provider Resolution Manager Senior

  • Job Family: Claims
  • Type: Full time
  • Date Posted:
  • Req #: JR15921

Location:

  • California, California
  • Utah, Utah
  • Arizona, Arizona
  • Washington, Washington
  • Nevada, Nevada
  • Colorado, Colorado

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Description

Responsible for providing quality, accessible and comprehensive service to the company's provider community.

How you will make an impact:

  • Develop and maintain positive provider relationships with provider community by regular and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.
  • Periodic on-site visits as needed.
  • Serve as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction; research and resolve the most complex provider issues and appeals for prompt resolution.
  • Work with internal matrix partners to triage issues and submit work requests.
  • Is assigned all Tiers of Hospitals/Facilities and/or National Ancillary provider groups.
  • Function as a high level technical resource to resolve or facilitate complex provider issues.
  • In collaboration with Provider Experience, coordinate Joint Operation Committees (JOC) of hospital/facility and/or National Ancillary provider groups, driving the meetings in the discussion of issues and changes.
  • Provide assistance regarding Annual Provider Satisfaction Surveys and required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues.
  • Coordinate communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
  • Manage inventory impacting up to $500M A/R.
  • Conduct claim and trend analysis.
  • Coordinate prompt claims resolution through direct contact with providers, claims, pricing and medical management department.
  • Identify and report on provider utilization patterns which have a direct impact on the quality of service delivery.
  • Research issues that may impact future provider negotiations or jeopardize network retention.
  • May be responsible for monitoring department metrics, provider assignments and oversight of daily activities.

Minimum Requirements:

  • Requires a Bachelor's degree and a minimum of 5 years of customer service experience ; or any combination of education and experience, which would provide an equivalent background.
  • Claims knowledge preferred.

Preferred Skills, Capabilities and Experience:

  • Claims Experience is highly preferred. This may include handling complex high dollar claims and ensuring claim payment accuracy.
  • Provider Relations/Provider experience is highly preferred.
  • Contracting and Credentialing experience is preferred.
  • Experience using Facets is a plus.

Applicable to Colorado Applicants Only

Annual Salary Range*: $76,000 - $95,000

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

* The hourly or salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting.  The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future.  No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.


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 ability@icareerhelp.com for assistance.

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