The Provider Contract Spec I assists with submitting contracts, credentialing and demographic changes to configurations for processing. Auditing contract loads to ensure accurate claim processing and payment. Answer inbound calls from providers in the phone queue. Assist with basic provider portal issues and upload medical records to HEDIS portal.
How you will make an impact:
- Processes standard provider contracts and works with internal departments to facilitate new and re- contracting efforts for all networks in a defined health service area.
- Primary duties may include, but are not limited to: Conducts formal review of Contracts and Credentialing documents.
- Coordinates the approval and issuance of all provider contracts to appropriate parties such as credentialing, reimbursement, and provider database.
- Creates boilerplate provider contracts and selects and inserts optional paragraphs/riders as directed.
- Maintains automated status logs and prepares monthly and periodic reports.
- Coordinates with provider database to ensure that provider reimbursements are loaded in accordance with contractual agreements and that provider data is current.
- Responds to providers regarding status of documents and other contracting related issues.
- May create and maintain provider files and related documentation and process provider data changes and provider terminations.
- Requires a H.S. diploma and at least 1 year of related experience with provider contracts, plan procedures, and policies; or any combination of education and experience which would provide an equivalent background.
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.ElevanceHealth.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 email@example.com for assistance.