Provider Relationship Account Consultant

Anticipated End Date:

2025-09-05

Position Title:

Provider Relationship Account Consultant

Job Description:

Locations: Durham North Carolina, Winston Salem NC, Charlotte, NC

Hours: Monday - Friday

Travel: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement.

Position Overview:

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

How You Will Make an Impact:

• Collaborates with internal matrix partners to triage issues and submit work request

• 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 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

• 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

Required Qualifications:

• 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 Qualifications:

• Travels to worksite and other locations as necessary.

• Experience with presentations to large groups as well as leadership strongly preferred

• Familiarity with Department of Social Services Initiative in North Carolina

• Provider Networking experience is a must have

• Provider facing experience is a must have

• Claims analysis experience strongly preferred

• Experience with presentations to large groups as well as leadership strongly 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