Anthem, Inc. Network Relations Consultant Manager in Raleigh, North Carolina
SHIFT: Day Job
Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, 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.
Network Relations Consultant Manager
Remote opportunity-North Carolina (Preferred location – reside in one of the following cities- Boone, Thomasville, Lexington, Mocksville, Denton, Winston-Salem, High Point, Clemmons, Kernersville, Lewisville, Asheboro, Randleman, Trinity, Greensboro, Jamestown, Summerfield, Eden, Madison, Reidsville, Danbury, Mount Airy, Asheville, Black Mountain, Marion, Weaverville, Marshall, Waynesville, Sylva, Glenville, Brevard, Hendersonville, Fletcher, Robbinsville, Topton, Andrews, Murphy Hayesville, Franklin, Glenville, Highlands Lenoir, Morganton, Bryson City), NC
Possible other locations include; Cary, NC, Raleigh-Durham, NC
Responsible for supporting the day-to-day overseeing of the Network Relations Consultants. As a knowledge and resource expert, handles escalated provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution. Identifies deficiencies and recommends corrective actions. Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery. Ensures Network Relations Consultants are meeting provider visit requirements. Attends provider meetings as needed. Monitors department metrics, provider assignments. Oversees daily activities and provides feedback to manager on performance management, day-to-day training, guidance, and workflow. Leads and facilitates team meetings. Serves as subject matter expert who may be assigned major projects within the department.
May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
Researches, analyzes and recommends resolution for contract disputes, non-routine claim issues, billing questions and other practices.
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.
Provides 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 conducts provider refresher training.
Researches issues that may impact future provider negotiations or jeopardize network retention.
Managed care experience to include provider training orientations, claims resolution (end to end) and medical policy required.
Previous experience with Department of Health and Human Services.
Provider Relations/Provider customer service experience preferred.
Experience with Joint Operating Committees (JOC), a plus.
Network contracting experience preferred.
Excellent verbal and written communication skills.
May require up to 80% day travel.
Requires a Bachelor's degree; 7 years of network relations and leadership experience; or any combination of education and experience, which would provide an equivalent background. Some travel may be required.
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. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.