Description SHIFT: Day JobSCHEDULE: Full-timeYour talent. Our Vision. At Simply Healthcare, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. We are a Florida licensed health maintenance organization that serves individuals enrolled in Medicaid and/or Medicare programs, 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. The Provider Network Manager I develops the provider network through contract negotiations, relationship development, and servicing. Primary focus of this role is contracting and negotiating contract terms.Primary duties may include, but are not limited to:
Typically works with less complex providers which may include, but are not limited to, professional providers, practice groups, small medical groups, providers in less competitive markets, and providers with greater familiarity with managed care concepts.
Contracts tend to be more standard and afford less opportunity for customization.
Fee schedules are fairly standardized with reimbursement models limited and well-defined.
May participate in intra-departmental projects or smaller projects impacting multiple departments.
Operates with general supervision, elevating unusual situations to management as required.
Solicits participation in the network and conducts re-contracting efforts as needed.
Serves as a communication link between professional providers and the company.
Conducts limited negotiations and drafts documents.
Assists in preparing financial projections as required.
Local travel required (70%)
Qualifications A BA/BS degree; 2 years’ experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background. Key Qualifications:
2+ years’ experience in Network Development preferred.
2+ years’ experience with Medicaid highly preferred.
Medicare experience preferred.
Previous provider contracting experience highly preferred.
Excellent influencing and negotiating skills.
Ability to explain complicated financial terms and utilization data to physicians and staff.
Excellent written skills and the ability to speak publicly are essential.
Advanced MS Word and Excel skills.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 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.REQNUMBER: PS37406