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A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

Provider Relationship Account Manager Sr

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

How will you make an impact:

• Develops and maintains positive provider relationships with 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 complex provider issues impacting provider satisfaction; research, 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 with 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.

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

• Organizes and executes external Provider Town Halls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA).

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

• May be responsible for monitoring department metrics, provider assignments and oversight of daily activities and provide feedback to manager on performance management, day-to-day training, guidance, and workflow of Provider Relationship Account Mgt. Consultants/Managers.

*Monday -Friday 9 am - 5:30 pm EST*

*Candidate MUST be a resident of Maryland*

*Candidate must be willing to report to the office a minimum of one day a week*

Minimum Requirements:

• Requires a bachelor’s degree; a minimum of 5 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 Skills, Capabilities and Experiences:

• Travels to worksite and other locations as necessary.