Network Relations Consultant

Position Overview The Network Relations Consultant acts as the primary resource for assigned, high‑profile providers or groups (i.e., local, individual providers, small groups/systems). The role establishes, oversees, and maintains positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education needs. Responsibilities Conduct initial provider orientations and ongoing educational outreach. Conduct Provider Forums in conjunction with the team. Educate providers regarding policies and procedures related to referrals, claims submission, credentialing documentation, website education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface. Enhance account relationships by investigating, documenting, and resolving provider matters and handling account changes and correspondence. Act as a liaison between the provider and the health plan, ensuring coordinated efforts to improve financial and quality performance. Monitor service capabilities and collaborate with cross‑functional departments to meet constituents’ needs, escalating issues related to claims payment, contract interpretation, parameters, or accuracy of provider contract or demographic information. Support operational activities such as database management and contract coordination, including submitting updates to demographics or roster modifications to maintain data integrity. Ensure compliance with health‑plan, corporate, state, and federal regulations. Report to work consistently during core business hours (8:00am to 5:00pm). Provide responsive, professional customer service to internal and external customers. Escalate issues to management in a timely manner. Meet or exceed a productivity standard of 10–12 provider visits per week. Conduct site visits when required. Travel as needed. Required Qualifications Candidate must reside within the State of Ohio. Minimum 3 years of recent Healthcare Claims experience. Excellent analytical and problem‑solving skills. Strong communication and presentation skills. Strong Microsoft Office Suite experience (Word, Excel, Teams). Must be able to travel. Preferred Qualifications Recent Managed Care Network experience in Provider Relations or Network Relations. Behavioral Health experience. Medicaid experience. Strong Microsoft Word and Excel experience. Education Associate’s degree or equivalent experience (high school diploma plus two years of relevant experience). Other Requirements Anticipated weekly hours: 40 hours per week. Full‑time, core business hours 8:00am to 5:00pm. Pay Range The typical pay range for this role is: $46,988.00 – $102,000.00. The actual base salary offer will depend on experience, education, geography and other relevant factors. The position is eligible for a bonus, commission or short‑term incentive program in addition to the base pay range. Benefits Eligible for a comprehensive benefits package that includes medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and additional resources based on eligibility. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr 4004 Aetna Medicaid Administrators