**Network Relations Consultant, LTSS Provider Representative** **Location:** Kansas. This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Kansas Elevance Health PulsePoint locations. The **Network Relations Consultant, LTSS Provider Representative** develops and maintains positive provider relationships with the Kansas LTSS provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues. Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution. **How you will make an impact:** + May be responsible for coordinating non-negotiated contracts for new and existing providers as needed. + Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices. + May participate in Joint Operation Committees (JOC) of larger provider groups. + Coordinates communication process on such issues as 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. + Provide assistance regarding education, contract questions and non-routine claim issues. + Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns. + Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department. + Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery. + Tracks and conduct 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 experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background. **Preferred Skills, Capabilities and Experiences:** + Previous experience providing resolution of issues that include but are not limited to: Enrollment/eligibility determinations; credentialing issues; authorization issues; and Claims processing/payment disputes is highly preferred. Don't see the position you are looking for? Join our talent community where you'll be updated with the latest news from our team. For a more direct conversation about opportunities at KanCare, or to discuss our business, culture, our team, and beyond, feel free to reach out to me directly at: robin.zimmermann@elevancehealth.com