Vacancy expired!
Description SHIFT: Day JobSCHEDULE: Full-timeYour
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 benefits companies and a
Fortune Top 50 Company.This position will be responsible
for overseeing the Western geographic location within Maryland.This position requires reporting to the 7550 Teague RoadHanover, MD 21076 location every Monday and as needed. The remainder of the week will be out on the field. Primary duties may 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
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 participate 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 Qualifications:
Requires a Bachelor's degree; 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.
Anthem, Inc. is ranked as one of
America’s Most Admired Companies among health insurers by Fortune magazine and
is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more
about our company and apply, please visit us at antheminc.com/careers. An Equal
Opportunity Employer/Disability/VeteranREQNUMBER: PS33144
Vacancy expired!