Anticipated End Date:

2024-11-29

Position Title:

Provider Experience Manager

Job Description:

Locations:  Mason OH, Columbus OH, Seven Hills OH, Cincinnati OH

Hours: Monday - Friday

Travel: Hybrid (1-2 days per week)

Position Overview:

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

How You Will Make an Impact:

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, 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

Required Qualifications:

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.

Preferred Qualifications:

Provider relations experience strongly preferred

Provider contract language preferred

Ohio Medicaid experience strongly preferred

Public speaking experience preferred

Medicaid professional and facility Claims/billing knowledge preferred

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

PND > Provider Relationship Account Mgmt

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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 elevancehealthjobssupport@elevancehealth.com for assistance.