Network Relations Consultant (NC Medicaid Alliance Operations) - PS28877 at Anthem, Inc.

Posted in Management 20 days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Asheville, North Carolina





Job Description:

Anthem is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.

Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, 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.

  

Network Relations Consultant

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, Glenville, Highlands Lenoir,  Morganton, Bryson City, NC

 

The Network Relations Consultant will develop and maintain positive provider relationships with the provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the 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. 


  • 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.

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. Up to 50% travel may be required.

 

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.