Anthem, Inc. Network Relations Consult Sr in Lincoln, Nebraska
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.
The primary duties of the Network Relations Consult Sr include, but are not limited to:
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.
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.
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 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.
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.
Travel may be required.
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.