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Provider Experience Consultant - Athens - 30606

Company: anthem
Location: Athens
Posted on: June 12, 2021

Job Description:

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PROVIDER EXPERIENCE CONSULTANT

Location: Athens, GA Job Family: Provider Network Management Req #: PS48249-Athens-Athens Date Posted: Jun 1, 2021

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater 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

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

Education/experience

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.

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 Worlds Most Admired Companies among health insurers by Fortune magazine, and a 2020 Americas 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.

Keywords: anthem, Athens , Provider Experience Consultant - Athens - 30606, Other , Athens, Georgia

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