Network Services Spec

Job ID: JP00045434

Anticipated Start Date: 04/21/2025

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

Primary duties may include, but are not limited to:

• Reviews incoming contracts and works with the Provider Relations Reps, IPA contacts and credentialing department to facilitate new and re-contracting efforts for AH, HMO and PPO products.
• Works with hospital bill managers in resolving issues relating to hospitals in the health service area.
• Research pended claims and identify the problems and correct either internally or via provider education.
• Assists in auditing provider database to ensure integrity of provider data.
• Monitors and resolves CSS issues with members.
• Reviews professional claims to determine correct reimbursements (pre and post processing) to support network contract agreements.
• Interacts with all applicable internal departments and physician reviewers, keeping abreast of health care trends, HCFA changes and supporting provider education relating to reimbursement and appropriate coding.

Requirements:

• Requires a H.S. diploma; or any combination of education and experience, which would provide an equivalent background.
• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
• Secondary degree strongly preferred.

Job Type: Contract Opportunity

Additional Details:

• Work Schedule: 8:00am-5:00pm
• Location: (Onsite) 1831 Chestnut Street St. Louis, MO USA, 63103.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.