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Network Relations Consultant Manager

Company: Anthem, Inc.
Location: Raleigh
Posted on: April 8, 2021

Job Description:

Welcome to the Anthem Careers site! We have been hard at work to improve our job search and application systems to better serve you. It is now easier to find and apply for relevant jobs as well as stay connected with Anthem. Here are a few of the updates you may notice:

  • No more profiles! We no longer require you to create a log in and password to apply for a job and you won't be able to access previously created profiles, but don't worry - we still have your previous application(s) on file and you can still track your status by clicking on the "Track Your Job Application Status" button.
  • Job Alerts - If you had previously registered to receive job alerts and wish to continue to receive these notifications, please re-register by clicking the "job alert" button.
  • NEW! Didn't find a job that is right for you? Join a Talent Network to stay informed on news and job opportunities with the Anthem Team! It is important that you apply using an email address which is unique to you and not shared with a friend, relative, spouse, or significant other. Our recruiting system uses your email address as your unique identifier. If you apply with a shared email address, your application will overwrite any previous applicant record with the same email address. Additionally, please ensure that you use a valid email address, free from typos, as there are a variety of communications which may be sent to the email address with which you apply 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. Remote opportunity-North Carolina (Preferred location - reside in one of the following cities- Boone, Thomasville, Lexington, Mocksville, Denton, Winston-Salem, High Point, Clemmons, Kernersville, Lewisville, Asheboro, Randleman, Trinity, Greensboro, Jamestown, Summerfield, Eden, Madison, Reidsville, Danbury, Mount Airy, 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 Possible other locations include ; Cary, NC, Raleigh-Durham, NC Responsible for supporting the day-to-day overseeing of the Network Relations Consultants. As a knowledge and resource expert, handles escalated provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution. Identifies deficiencies and recommends corrective actions. Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery. Ensures Network Relations Consultants are meeting provider visit requirements. Attends provider meetings as needed. Monitors department metrics, provider assignments. Oversees daily activities and provides feedback to manager on performance management, day-to-day training, guidance, and workflow. Leads and facilitates team meetings. Serves as subject matter expert who may be assigned major projects within the department.
    • 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.
      • Previous experience with Department of Health and Human Services.
      • Provider Relations/Provider customer service experience preferred.
      • Experience with Joint Operating Committees (JOC), a plus.
      • Network contracting experience preferred.
      • Excellent verbal and written communication skills.
      • May require up to 80% day travel. Systems:
        • Contraxx
        • Sharepoint Requires a Bachelor's degree; 7 years of network relations and leadership experience; or any combination of education and experience, which would provide an equivalent background. Some travel may be required. 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. 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions. Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem. EEO is the Law Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees. Anthem, Inc. is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance. *WARNING : Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Please be advised that Anthem will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission here by selecting the 'Rip-offs and Imposter Scams' option. Anthem requires a completed online application for consideration of employment for any position.

Keywords: Anthem, Inc., Raleigh , Network Relations Consultant Manager, Executive , Raleigh, North Carolina

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