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Network Relations Consultant - Remote Work Available in WA or NC - PS15841

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Provider Network Management
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PS15841 Requisition #
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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 benefits companies and a Fortune Top 50 Company.

 

Develops and maintains positive relationships with providers and develops strategies for recruitment and contracting.

 

Primary duties may include, but are not limited to:

  • Develops and maintains positive relationships with the provider community by periodic on-site visits, communicating administrative or programmatic changes and facilitating the resolution of provider issues.
  • Recruits providers to build a cost effective, high quality provider network. Conducts negotiations and leads contracting efforts with providers to build and maintain a cost effective, accessible provider network.
  • Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
  • 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 and Blue Cross and Blue Shield policies and procedures.
  • Identifies network access and deficiencies and develops recruitment and contracting strategies.
  • Coordinates and conducts provider training.

Requirements:

  • Requires a BA/BS degree; 3 years of related experience (provider relations, network management, customer service, sales-negotiation); prior negotiation experience; or any combination of education and experience, which would provide an equivalent background.
  • 5 years experience in customer service/sales/account management strongly preferred.
  • 2 years of claims experience preferred.
  • 2 years of managed care experience preferred.
  • Up 50% local 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 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.

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As we expand our technology and analytics capabilities, we are searching for associates that have a passion for analytics and the drive to pave the way in a growing industry.

Career opportunities are available in the following areas:

  • Strategy and planning: Ensures strategic alignment between HCA projects and the organization's broader goals. Also integrates analytics strategy into the execution process, including program management, project controls, communications and vendor oversight.
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  • Customer management analytics: Provides accurate, timely and reliable delivery of client reports, which include data analyses, insights and other information that demonstrates Anthem’s value as a business partner.
  • Financial management analytics: Works closely with HCA leaders and other Anthem management to provide support to the finance and accounting teams through financial reporting systems.
  • Member management analytics: This team is responsible for the risk adjustment program and analytics, the member management program, predictive analytics and member management analytic products management.
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