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Anthem, Inc. Network Relations Consult Sr (PS33937) in Glendale, California

Network Relations Consult Sr (PS33937)

Location: United States

New

Requisition #: PS33937

Post Date: 1 day ago

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.

This opportunity can work remotely if within the service area of St. Louis, MO Metro area. Relocation assistance is not available for this position.

The Network Relations Consultant Sr. 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 the most complex provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution.

  • May be responsible for contract negotiation for physician, and physician groups.

  • Functions as a high level technical resource to resolve or facilitate complex provider issues.

  • Coordinates Joint Operation Committees (JOC) of larger provider groups, driving the meetings in the discussion of issues and changes.

  • 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:

  • Bachelor's degree; 5 years of customer service experience including 2 years of experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.

  • Travel required, must have reliable transportation.

  • Healthcare Industry experience preferred.

  • Claims experience strongly preferred.

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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