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Network Relations Consultant - New York, NY - PS23184

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Provider Network Management
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PS23184 Requisition #



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.


The Network Relations Consultant 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.



Requires a Bachelor's degree; 3 years of customer service experience including 2 year’s 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 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

 

 


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Metrics & Data

Leverage your talents to make a difference in people's lives, by providing innovative, data-driven solutions that can measure and improve consumer's health.

Anthem metrics and data associates focus on creating innovative, data-driven solutions that can measure and track progress in our members’ health. Collaborate with internal and external experts to develop metrics-supported strategies for improving measurements and processes.

Enable physicians and hospitals to improve care with valuable information that improves care quality and affordability. Join us and help provide tools to help consumers make better decisions, as we create a simpler, more affordable, more accesible healthcare system.

Metrics and data associates at Anthem:

  • Develop statistical models and functional means for measuring the quality of health care members receive annually
  • Provide members with useful, powerful tools for self-evaluation and tracking of health issues and risk factors
  • Show initiative and make key decisions with the potential to dramatically influence patient outcomes and positively impact peoples' lives
  • Create thoughtful solutions that engage and empower members to make more informed decisions about their health and health care
  • Serve as a catalyst to improve the essential relationship between patient and health care provider
  • Leverage metrics and data to deliver resources that help overcome traditional coverage barriers such as education, literacy and language

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