Elevance Health
This listing was posted on Broadbean.
Provider Resolution Director - GBD
Location:
Indianapolis, IN
Description:
Provider Resolution Director - Government Business Division (JR132801)Location: Candidates must reside within 50 miles or 1-hour commute each way of the above Elevance Health PulsePoint location.Elevance Health supports a hybrid workplace model (virtual and office) with PulsePoint sites used for collaboration, community, and connection, with the in-office commitment for this role being 1-2 days in an office per week.The Provider Resolution Director is responsible for developing and maintaining positive provider relationships, dedicated to National Facility/ Ancillary provider groups with total annual spend up to $1B. May also be focused on multiple Facility contracts in one state or across a particular region of the state.How will you make an impact: * Conduct or collaborate on regular on-site and/or virtual/digital visits, communicates administrative and programmatic changes, and facilitates education and the resolution of provider issues. * Serving as a knowledge and resource expert regarding the most complex National Facility/Ancillary provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution. * Where the individual is focused on one state or across a particular region of the state, that individual shall take on a "Senior" role in collaborating with existing resolution staff as well as with their assigned accounts. * They will work with internal matrix partners to triage issues and submit work requests. * Functions as a high level technical resource to resolve or facilitate complex provider issues, both internally and externally. * Leads (or co-leads) Joint Operation Committees (JOC) of National Facility/ Ancillary provider groups or state-specific or regional accounts, driving the meetings in the discussion of issues and changes, specifically highlighting strategic opportunities. * Provides assistance regarding Annual Satisfaction Surveys and required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues. * Coordinates (or collaborates in) communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns. * Coordinates (or collaborates in) prompt claims resolution through direct contact with providers, claims, pricing and medical management department. * Manages inventory impacting up $500M A/R, conducts claim and trend analysis. * Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery. * Researches issues that may impact future provider negotiations or jeopardize network retention. * Shall provide mentorship, training, guidance to PRMs.Minimum Requirements: * Bachelor's degree and a minimum of 5 years of Provider service experience including 5 years' experience healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background.Preferred Qualifications: * Experience in any combination of Provider Resolution, Provider Data, Provider Relations, Provider Network Management, Contracting - within Medicaid a plus. * Claims Experience including handling complex claims and ensuring claim payment accuracy is highly preferred. * Provider Relations/Provider experience is highly preferred. * Contracting and Credentialing experience is preferred. * Understanding of Provider Data and Operations. * Experience with high level provider escalations. * Experience translating contract language into maintenance of data. * Experience presenting to leadership / executives.For candidates working in person or remotely in the below location, the salary* range for this specific position is $114,072 to $195,552Location: New YorkIn 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 range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.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 AreElevance 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 WorkAt 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, to name a few.Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.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. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.
Company:
Elevance Health
Posted:
November 13 on Broadbean
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More About this Listing: Provider Resolution Director - GBD
Provider Resolution Director - GBD is a Executive Director Job at Elevance Health located in Indianapolis IN. Find other listings like Provider Resolution Director - GBD by searching Oodle for Executive Director Jobs.
Provider Resolution Director - GBD is a Executive Director Job at Elevance Health located in Indianapolis IN. Find other listings like Provider Resolution Director - GBD by searching Oodle for Executive Director Jobs.