Provider Relationship Account Consultant

Overview

Anticipated End Date:

Position Title:

Provider Relationship Account Consultant

Location:

This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. Alternate locations may be considered.

Please note that per our policy on hybrid work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Provider Relationship Account Consultant will be responsible for providing quality, accessible and comprehensive service to the company's provider community while leveraging data-driven insights to drive improved Payment Integrity outcomes.

• Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and/or face-to-face outreach, by communicating administrative and programmatic changes, facilitating provider education and the resolution of provider issues.
• Collaborates with internal matrix partners to triage issues and submit work requests.
• Generally assigned to a portfolio of providers within a defined cohort.
• Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners while interpreting provider performance scorecards to identify root causes and recommend targeted interventions.
• 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, as well as outreach on a variety of initiatives and programs, focused on reducing administrative waste, improving documentation accuracy, and supporting digital tool adoption, while tracking the impact of provider engagement on medical savings, recovery cycle times, and compliance metrics. Said work will support identifying opportunities to refine audit selection criteria or engagement strategy based on observed trends.
• Coordinates and conducts provider training including developing and distributing provider relations materials.
• May assist with Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education and non-routine claim issues.
• May coordinate Provider Manual updates/maintenance.
• 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.

• Requires a bachelor’s degree; a minimum of 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.

• Experience with data interpretation, provider performance analytics, or payment integrity programs is strongly preferred.
• Ability to interpret patterns and insights from complex data sets and translate them into strategic, actionable plans for engaging providers is strongly preferred. This includes determining the optimal approach for each provider, shaping both operational and provider-facing process improvements, and proactively identifying opportunities for intervention.
• A self-starter who is highly organized, able to work independently, and capable of driving strategy from analysis through execution is strongly preferred.

For candidates working in person or remotely in the below location(s), the salary range for this specific position is $63,712 - $95,568.

Locations:
Illinois

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The…