Provider Relationship Account Consultant
Elevance Health, Costa Mesa, CA, United States
Provider Relationship Account Consultant
Location: Field
This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as required, with occasional office attendance for meetings and training. This approach ensures flexibility, responsiveness to client’s needs, and direct, hands‑on engagement.
Please note that per our policy on hybrid/virtual 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 develops and maintains positive provider relationships with the provider community by regular on‑site visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.
How you will make an impact
Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution.
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 participation 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 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 conducts 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. Travels to worksite and other locations as necessary.
For candidates working in person or virtually, the salary range for this position is $63,600 to $114,480.
Location(s): California
Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
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This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as required, with occasional office attendance for meetings and training. This approach ensures flexibility, responsiveness to client’s needs, and direct, hands‑on engagement.
Please note that per our policy on hybrid/virtual 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 develops and maintains positive provider relationships with the provider community by regular on‑site visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.
How you will make an impact
Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution.
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 participation 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 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 conducts 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. Travels to worksite and other locations as necessary.
For candidates working in person or virtually, the salary range for this position is $63,600 to $114,480.
Location(s): California
Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
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