Anthem, Inc. Senior Provider Contract Specialist in Latham, New York
SHIFT: Day Job
Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.
CareMore is a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations. Job description Inserted 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
The Senior Provider Contract Specialist f unctions with the expertise in managing negotiated pricing loads. Responsible for coordinating the process for more complex pricing arrangements involving high profile provider groups and/or physician groups tied to large hospital systems joining the network including creating standard contracts for providers as needed.
Primary duties may include, but are not limited to:
Manage provider update files submitted by delegated provider entities and/or large groups/integrated delivery system.
Prepare the information for timely and accurate submission to the Provider Data Management area.
Ensure updates/changes for existing network providers are interpreted and loaded accurately.
Ensure accurate and timely loading of professional and facility contracts across value based and fee for service agreements for provider solutions.
Works directly with contracting directors and managers to understand what is negotiated and how the negotiated agreement is translated into the company's systems resulting in accurate and timely loading. Performs internal audit of provider record, ensuring accuracy against rosters.
Serves as the go-to with matrix partners to resolve interpretation issues and ensure timely turnaround. Serve as local market expert supporting (and managing when necessary) the provider onboarding process and provider updates submitted by provider offices within defined market.
Must possess critical thinking skills, have a proven strong eye for detail and a focus on quality.
Requires a High School diploma
A minimum of 5 years’ experience with provider contracts, plan procedures, and policies
Working experience in WGS, CS90 or FACETS
Heavy Excel experience
Experience with JIRA or PEGASUS programs
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.