Anthem, Inc. Provider Contract Implementation Manager in New York City, New York
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 care companies and a Fortune Top 50 Company.
Serves as the single point of contact for Provider Contractors, Provider Relations, and Cost of Care staff for Provider Operations. Manages the end to end process related to the development, configuration and loading of provider reimbursement and demographics in order to maintain provider networks and contracting initiatives.
Primary duties may include, but are not limited to:
Serves as the demographics and pricing subject matter expert.
Oversees the timely and accurate configuration of provider contract reimbursement terms in pricing systems and oversees provider demographic data.
Reviews pricing methodology in provider contracts to ensure it is administratively feasible.
Collaborates with the Provider Contractor to create accurate provider facing rate sheets.
Validates rate sheet and supporting documents using knowledge of contract language and reimbursement methodology.
Researches and rectifies issues.
Develops and maintains relationships with Provider Data Management, Provider Pricing, Provider Contractors, Healthcare Analytics, Cost of Care staff and Provider Relations to ensure successful and proficient daily operations.
Educates Provider Contracting and Provider Relations in their roles as it relates to pricing development and provider demographic processes.
Requires a BA/BS degree in a health related field and minimum of 5 years’ experience in the health care industry with background in provider relations, facility contracts and reimbursement; or any combination of education and experience, which would provide an equivalent background.
MBA, MHA or related graduate degree and Coding Certification
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.