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Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At
Empire Blue Cross Blue Shield, a proud member of the Anthem, Inc. family of
companies, 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. The Network Relations Consultant 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 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 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
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.Qualifications Requires a
Bachelor's degree; 3 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 may be
required.Anthem, Inc. is ranked as
one of America’s Most Admired Companies among health insurers by Fortune
magazine and has been named a 2019 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.REQNUMBER: PS36529
