Anthem Network Relations Consultant - Regulatory Mandates, Anthem Office, Mendota Heights, MN (139038) in Wichita Falls, Texas
/ 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 benefits companies and a Fortune Top 50 Company.
This position is located onsite at the Mendota Heights, MN Anthem Office
The Network Relations Consultant (Regulatory Mandates) develops and maintains positive relationships with providers and develops strategies for recruitment and contracting.
Primary duties may include, but are not limited to:
Engage in regulatory mandates which impact networks
Attend regulatory and mandate calls
Ability to contribute and understand network requirements
Tracking and reporting of mandated action items
Manage product specific recruitment and tracking
Improvement of policies and procedures regarding recruitment activity and tracking
Strategically formulate a network recruitment guarantee and plan of action
May attend various conferences
Develops and maintains positive relationships with the provider community by periodic on-site visits, communicating administrative or programmatic changes and facilitating the resolution of provider issues.
Recruits providers to build a cost effective, high quality provider network.
Conducts negotiations and leads contracting efforts with providers to build and maintain a cost effective, accessible provider network.
Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
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 and Blue Cross and Blue Shield policies and procedures.
Identifies network access and deficiencies and develops recruitment and contracting strategies. Coordinates and conducts provider training.
Requires a BA/BS degree; 3 years of related experience (provider relations, network management, customer service, sales-negotiation); prior negotiation experience; or any combination of education and experience, which would provide an equivalent background.
/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran./
Job Provider Network Management
Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Network Relations Consultant - Regulatory Mandates, Anthem Office, Mendota Heights, MN (139038)
Location: texas-Wichita Falls
Other Locations: MN-Mendota Heights
Requisition ID: 139038