LTSS Network Relations Consultant

LTSS Network Relations Consultant Location : 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 or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands‑on engagement. Candidates must reside in Dayton or Cincinnati metro area. The LTSS Network Relations Consultant is responsible for developing and maintaining 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, researching and resolving 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 resolutions for contract disputes, non‑routine claim issues, billing questions and other practices. May participate in Joint Operation Committees (JOC) of larger provider groups. Coordinates communication processes on 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. Provides assistance regarding education, contract questions and non‑routine claim issues. Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management departments. 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 as a Network Management Representative; or any combination of education and experience that provides an equivalent background. Preferred Skills, Capabilities and Experiences Experience working with LTSS and/or Waiver populations preferred. Strong communication skills (written and verbal), especially when communicating with various customers and support teams. Healthcare insurance experience strongly preferred. Experience in claims service operations preferred. Experience with Microsoft Office and/or ability to learn new computer programs/systems/software quickly highly preferred. Benefits We offer a range of market‑competitive total rewards that include merit increases, paid holidays, paid time off, incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long‑term disability benefits, a 401(k) with match, a stock purchase plan, life insurance, wellness programs and financial education resources. Equal Employment Opportunity 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 View email address on click.appcast.io for assistance. Background Checks 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. Florida Law Screening Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration. #J-18808-Ljbffr