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Anthem, Inc. Network Relations Consultant in Downey, California
SHIFT: Day Job
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 care companies and a Fortune Top 50 Company.
Network Relations Consultant
Must be located within San Bernardino County/region, California for this position; will consider a remote arrangement
The Network Relations Consultant will develop and maintain positive provider relationships with the provider community by regular on-site visits, communicating administrative and program 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 a 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 that have a direct impact on the quality of service delivery.
Tracks and conducts 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 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.
Travel required - 25-75% within provider network
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.