Network Relations Consult - PS33144

Network Relations Consult - PS33144Location: United StatesNewRequisition #: PS33144YourTalent. 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 thefuture 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 responsiblefor 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 providerrelationships with provider community by regular on-site visits, communicatingadministrative and programmatic changes, and facilitating, education and theresolution of provider issues.

Serving as a knowledge and resource expert regardingprovider issues impacting provider satisfaction, researches and resolvescomplex provider issues and appeals for prompt resolution.

May be responsible for coordinatingnon-negotiated contracts for new and existing providers as needed.

Researches, analyzes and recommends resolutionfor contract dispute, non-routine claim issues, billing questions and otherpractices.

May participate in Joint Operation Committees(JOC) of larger provider groups. Coordinates communication process on suchissues as administrative and medical policy, reimbursement and providerutilization patterns.

Conducts seminars to support the understanding ofmanaged care policies and procedures.

Identifies network access and deficiencies anddevelops recruitment and contracting strategies.

Coordinates and conducts provider trainingincluding developing and distributing provider relations materials.

Responsible for providing quality, accessible andcomprehensive service to the company's provider community.

Provide assistance regarding education, contractquestions and non-routine claim issues.

Coordinates communications process on such issuesas administrative and medical policy, reimbursement and provider utilizationpatterns.

Coordinates prompt claims resolution throughdirect contact with providers, claims, pricing and medical managementdepartment.

Identifies and reports on provider utilization patternswhich have a direct impact on the quality of service delivery.

Tracks and conduct provider refresher training.

Researches issues that may impact future providernegotiations or jeopardize network retention.

Qualifications:

Requires a Bachelor's degree; 3 years of customerservice experience including 2 years’ experience as a Network Management Rep;or any combination of education and experience, which would provide anequivalent background.

Travel may be required.

Anthem, Inc. is ranked as one ofAmerica’s Most Admired Companies among health insurers by Fortune magazine andis a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn moreabout our company and apply, please visit us at antheminc.com/careers. An EqualOpportunity Employer/Disability/Veteran