Anthem, Inc. Network Relations Consult Sr in Springfield, Missouri
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 Network Relations Consultant Sr is responsible for:
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 that 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.
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.
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.