Anthem, Inc. Network Relations Consultant in Los Angeles, California
SHIFT: Day Job
Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.
CareMore is a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.
Duties & Responsibilities
• 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 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. • 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 conduct provider refresher training. • Researches issues that may impact future provider negotiations or jeopardize network retention.
Minimum requirements • 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.
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.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.
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. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.