Anthem Inc. Veterans Jobs

Job Information

Anthem, Inc. Provider Experience Consultant in Glendale, California

Description

SHIFT: Day Job

SCHEDULE: Full-time

Responsible for providing quality, accessible and comprehensive service to the company's provider community.

  • Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and face-to-face outreach, by communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues. '

  • Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction; researches and resolves complex provider issues and appeals for prompt resolution.

  • Works with internal matrix partners to triage issues and submit work requests.

  • Assigned to Tier 2 and 3 providers.

  • 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 routine outreach to support the understanding of managed care policies and procedures.

  • Coordinates and conducts provider training including developing and distributing provider relations materials.

  • Provides assistance regarding Annual Provider Satisfaction Surveys and required corrective action plan implementation and monitoring, education, and non-routine claim issues.

  • Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.

  • Coordinates Provider Manual updates/maintenance.

  • 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.

  • 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.

Preferred:

  • Knowledgeable in the Medicaid sector with equivalent experience working with a Provider Medical Group (PMG), Independent Physician Association (IPA), Management Services Organization (MSO), and/or a Hospital Systems.

  • Familiar with California State Agencies including the Dept. of Managed Health Care (DMHC), Dept. of Health Care Services (DHCS), and local Southern California health plan models (i.e. Two Plan Model, LA Care Health Plan)

    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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.

    REQNUMBER: PS51805

DirectEmployers