Provider Relationship Account Consultant

Anticipated End Date:

2025-06-23

Position Title:

Provider Relationship Account Consultant

Job Description:

Provider Relationship Account Consultant

Location: Hybrid1: This role requires associates be in the office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance.  This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.  Alternate locations may be considered.

Carelon Behavioral Health, Inc. is enthusiastically supporting the CYBHI Fee Schedule Fee Schedule program managed by the Department of Health Care Services (DHCS) as their dedicated Third-Party Administrator. Our goal? To improve the mental health services offered to California's young students via this pivotal initiative.

We're expanding our team and eager to connect with professionals experienced in healthcare administration, network management, provider relations, and program support. With this program, we're aligning our goals with Governor Newsom's Kids’ Mental Health and the Children and Youth Behavioral Health Initiative (CYBHI). We're working closely with DHCS, the Department of Managed Health Care (DMHC), and the California Department of Insurance (CDI) to implement a multi-payer fee schedule, ensuring fair reimbursement for school-linked providers offering designated outpatient mental health and substance use disorder services.

The Provider Relationship Account Consultant is responsible for providing quality, accessible and comprehensive service to the company's provider community. Providers in this program include Local Education Agencies, County Offices of Education, public Institutions of Higher Education, Billing Vendors and Affiliated Providers.

How you will make an impact: 

• Develop and maintain 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.
• Coordinates communication process on such issues as administrative and program 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. 
• 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. 

Minimum Requirements:

• 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.  

Preferred Skills, Capabilities and Experiences:

• Experience working in the behavioral health field. 
• Experience working in provider relations.
• Experience in education system.
• Experience with Medi-Cal.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $66,608 to $104,256

Locations:  California

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 Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the ran