Provider Relationship Account Consultant

Elevance Health; Costa Mesa (CA); Hybrid; USD 66,000 - 105,000; Full time

Job summary

A leading healthcare company is seeking a Provider Relationship Account Consultant to enhance provider relations and support quality service delivery. This role involves managing provider portfolios, resolving issues, and conducting outreach to improve satisfaction. The position offers a hybrid work model with a competitive salary range based on experience.

Benefits

Comprehensive Benefits Package

Incentive Programs

401(k)

Stock Purchase Options

Qualifications

• 2 years of customer service experience, including 1 year in healthcare.

Responsibilities

• Develop and maintain positive provider relationships.
• Manage a portfolio of providers within a defined cohort.
• Conduct outreach and provider training.

Skills

Customer Service

Provider Relations

Behavioral Health

Education

Bachelor’s Degree

Job description

Anticipated End Date: 2025-05-22

Position Title: Provider Relationship Account Consultant

Job Description

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

Location

Woodland Hills, Costa Mesa, and Walnut Creek, CA. This role requires associates to be in the office 1-2 days per week, fostering collaboration and connectivity, while supporting productivity and work-life balance. This approach combines structured office engagement with virtual work autonomy, promoting a dynamic and adaptable workplace.

About Us

Carelon Behavioral Health, Inc. supports the CYBHI Fee Schedule program managed by the Department of Health Care Services (DHCS), aiming to improve mental health services for California's young students. We are expanding our team and seek professionals in healthcare administration, network management, provider relations, and program support, aligning with initiatives like Kids’ Mental Health and CYBHI.

Key Responsibilities

1. Develop and maintain positive provider relationships via email, phone, and face-to-face interactions, communicating changes, educating providers, and resolving issues.
2. Collaborate with internal teams to triage issues and submit work requests.
3. Manage a portfolio of providers within a defined cohort.
4. Research, analyze, and coordinate prompt resolution of provider issues and appeals.
5. Coordinate communication on policies, reimbursement, and utilization patterns.
6. Conduct outreach and provider training, developing and distributing related materials.
7. Assist with Provider Satisfaction Surveys, corrective action plans, and claim issues.
8. Update and maintain the Provider Manual.
9. Identify and report on provider utilization patterns impacting service quality.
10. Research issues affecting future provider contracts and network retention.

Minimum Requirements

• Bachelor’s degree and at least 2 years of customer service experience, including 1 year in healthcare or provider environment, or equivalent education and experience.

Preferred Skills and Experience

• Experience in behavioral health, provider relations, education system, or Medi-Cal.

Compensation and Benefits

The salary range for this position in California is $66,608 to $104,256. Benefits include a comprehensive package, incentive programs, stock purchase, 401(k), and more. Actual salary will depend on experience, education, and market factors.

Additional Information

This role is a non-management, exempt position within the PND > Provider Relationship Account Mgmt family. Elevance Health values diversity and is an equal opportunity employer. We require COVID-19 and Influenza vaccinations for certain roles, with accommodations available upon request. Our hybrid work model involves working onsite at least once per week unless specified otherwise.