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Elevance Health · 22 hours ago

Provider Relationship Account Manager

TX-GRAND PRAIRIE, 2505 N HWY 360, STE 300

Full-time

Hybrid

Mid Level

3+ years exp

Elevance Health is a health company dedicated to improving lives and communities. They are seeking a Provider Relationship Account Manager responsible for providing comprehensive service to the provider community in Texas, developing relationships, resolving issues, and coordinating communications regarding managed care policies.

Health CareHealth InsurancePersonal HealthWellness

Responsibilities

Develops and maintains positive provider relationships with the provider community by regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues

Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention; researches, analyzes, and coordinates prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners

Collaborates within a cohort of internal matrix partners to triage issues and submit work requests

Generally, it is assigned to a portfolio of providers within a defined cohort

Coordinates Joint Operation Committees (JOC) of provider groups, driving the meetings in the discussion of issues and changes

May assist Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues

Coordinates communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns

Conducts proactive outreach to support the understanding of managed care policies and procedures, as well as on a variety of initiatives and programs. Participates in external Provider Townhalls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA)

Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery

Research issues that may impact future provider contract negotiations or jeopardize network retention

Qualification

Customer serviceHealthcare experienceProvider relationship managementIssue resolutionCommunication skills

Required

Requires a bachelor's degree; minimum of 3 years of customer service experience including 2 years of experience in a healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background