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Provider Resolution Director

Company: Elevance Health
Location: Harrisburg
Posted on: September 25, 2022

Job Description:

Provider Resolution Director

  • Job Family: Claims
  • Type: Full time
  • Date Posted:Aug 19, 2022
  • Req #: JR13629Location:
    • National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePointDescriptionThe Provider Resolutions 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.
      • 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.
      • Research issues that may impact future provider negotiations or jeopardize network retention.
      • Shall provide mentorship, training, guidance to PRMs.Minimum Requirements
        • Requires a Bachelor's degree
        • 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 Skills, Capabilities and Experience
          • Understanding of claims systems and how they work is required.
          • WGS experience strong preferred.
          • Facets experience is a plus.
          • Excellent communication skills including effective client facing communication is required.
          • Experience with issue research and resolution is required.
          • Must be available during eastern time zone hours.
          • Some travel may be required.Applicable to Colorado Applicants OnlyAnnual Salary Range*: $108,240 - $135,300Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
            • The hourly or 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. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. 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 Companys sole discretion, consistent with the law.Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.Be part of an Extraordinary TeamElevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?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.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide and Elevance Health approves a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 Worlds Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. 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 ability@icareerhelp.com for assistance.EEO is the LawEqual Opportunity Employer / Disability / VeteranPlease use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
              • EEO Policy Statement
              • EEO is the Law Poster
              • EEO Poster Supplement-English Version
              • Pay Transparency
              • Privacy Notice for California ResidentsElevance Health, Inc. is an E-verify EmployerNeed Assistance?Email us (elevancehealth@icareerhelp.com) or call 1-877-204-7664

Keywords: Elevance Health, Harrisburg , Provider Resolution Director, Executive , Harrisburg, Pennsylvania

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