Anthem, Inc. Network Relations Consultant Sr in Downey, California
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
NOTE: This position is work from home with the applicant's physical location being within a reasonable commute to any Anthem office.
Network Relations Consultant Sr
Develops and maintains positive provider relationships with provider community by regular web/tele-conference and/or 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 the most complex provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution.
Primary duties may include but are not limited to:
May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
Functions as a high-level technical resource to resolve or facilitate complex provider issues.
Coordinates Joint Operation Committees (JOC) of larger provider groups, driving the meetings in the discussion of issues and changes.
Provide assistance regarding education, contract questions and non-routine claim issues.
Coordinates communications process on such issues as administrative and clinical policy, coverage and reimbursement guidelines, and provider utilization patterns.
Collect feedback from providers through direct contact to gage experience and satisfaction with services.
Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery and uses data to inform providers.
Coordinate, post and/or distribute provider facing materials and conduct trainings as needed.
Researches issues that may impact future provider negotiations or jeopardize network retention.
May be required to attend community meetings to remain aware of policy changes and issues impacting providers.
Requires a Bachelor's degree; 5 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.
Prior provider relations experience, including provider facing presentations and training
Exposure to and/or basic knowledge of provider quality and performance audit measures
Prior claims processing and/or claims management experience
Travel may be required.
Proficient in Microsoft suite (Word, Excel, and PowerPoint)
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.