Anthem Inc. Jobs

Job Information

Anthem, Inc. Network Relations Consult in Charlotte, North Carolina

Description

SHIFT: Day Job

SCHEDULE: Full-time

Network Relations Consult:

Develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.

Primary duties may include, but are not limited to:

  • Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution.

  • 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 participation 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.

Qualifications

Minimum Qualifications:

  • 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.

  • Travel may be required.

    Preferred Qualifications:

  • NC Medicaid Experience Preferred

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.

REQNUMBER: PS60232-Charlotte-Charlotte

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