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Elevance Health Network Relations Consultant (LTSS Provider Rep) in Wichita, Kansas

Network Relations Consultant, LTSS Provider Representative

Location: Kansas. This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Kansas Elevance Health PulsePoint locations.

The Network Relations Consultant, LTSS Provider Representative develops and maintains positive provider relationships with the Kansas LTSS provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues. Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution.

How you will make an impact:

  • May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.

  • Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.

  • May participate in Joint Operation Committees (JOC) of larger provider groups.

  • Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.

  • Conducts seminars to support the understanding of managed care policies and procedures.

  • Identifies network access and deficiencies and develops recruitment and contracting strategies.

  • Coordinates and conducts provider training including developing and distributing provider relations materials.

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

  • Provide assistance regarding education, contract questions and non-routine claim issues.

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

  • 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.

  • Tracks and conduct provider refresher training.

  • Researches issues that may impact future provider negotiations or jeopardize network retention.

Minimum requirements:

  • Requires a Bachelor's degree and a minimum of 3 years of customer service experience including 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Previous experience providing resolution of issues that include but are not limited to: Enrollment/eligibility determinations; credentialing issues; authorization issues; and Claims processing/payment disputes is highly preferred.

Don't see the position you are looking for? Join our talent community where you'll be updated with the latest news from our team. For a more direct conversation about opportunities at KanCare, or to discuss our business, culture, our team, and beyond, feel free to reach out to me directly at: robin.zimmermann@elevancehealth.com