Network Relations Consultant at Anthem in Raleigh, NC

Description

SHIFT: Day Job

SCHEDULE: Full-time

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

Remote opportunity-North Carolina (Preferred location - reside in one of the following cities- Asheville, Black Mountain, Marion, Weaverville, Marshall, Waynesville, Sylva, Glenville, Brevard, Hendersonville, Fletcher, Robbinsville, Topton, Andrews, Murphy, Hayesville, Franklin, Highlands Lenoir, Morganton, Bryson City), NC

Possible other locations include; Cary, NC, Raleigh-Durham, NC

The Network Relations Consultant will develop and maintain positive relationships with the provider community by regular on-site visits, communicating administrative and programmatic changes, conducting provider education and offers resolution of provider issues. You will serve as a knowledge and resource expert regarding provider issues impacting provider satisfaction, research and resolve complex provider issues and appeals for prompt resolution for HealthyBlue, NC plan.

• May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
• Researches, analyzes and recommends resolution for contract disputes, non-routine claim issues, billing questions and other practices.
• 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.
• Provides 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 conducts provider refresher training.
• Researches issues that may impact future provider negotiations or jeopardize network retention.

Qualifications

Additional Experience:

• Managed care experience to include provider training orientations, claims resolution (end to end) and medical policy required.
• Provider Relations/Provider customer service experience preferred.
• Network contracting experience preferred.
• Excellent verbal and written communication skills.
• May require up to 80% day travel.

Systems:

• Facets
• Contraxx
• Sharepoint

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 may be required.