Primary duties may include, but are not limited to:
- Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction; researches and resolves less complex provider issues and appeals for prompt resolution.
- Works with internal matrix partners to triage issues and submit work requests.
- Assigned to Tier 2 and 3 providers.
- Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
- Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
- Conducts routine outreach to support the understanding of managed care policies and procedures.
- Coordinates and conducts provider training including developing and distributing provider relations materials.
- Provides assistance regarding Annual Provider Satisfaction Surveys and required corrective action plan implementation and monitoring, education, and non-routine claim issues.
- Coordinates Provider Manual updates/maintenance.
- Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department.
- Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.
- Researches issues that may impact future provider negotiations or jeopardize network retention.
- Requires a Bachelor's degree;
- 2 years of customer service experience including 1 year of experience in a healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background.
- Travel may be required.
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 email@example.com for assistance.