Anthem Manager I Provider Network Management Relations (Nationwide) #127336 in Andover, Massachusetts
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re 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.
_Manager I Provider Network Management Relations (Work From Home Opportunity)_
Responsible for developing and expanding Amerigroup physician, physician group, IPA, hospital and ancillary networks and managing the functions relating to provider servicing, provider education, and network development.
Primary duties may include, but are not limited to:
Coordinates the management and growth of specialty provider networks for assigned health plans and new market/program growth opportunities; assists in monitoring resolving specialty provider network concerns and issues.
Manages advocacy/education process with specialty providers and key stakeholders.
Develops and implements processes that ensure specialty provider claims are paid accurately, timely, and on first submission.
Monitors team activities to assure that staff meetsperformance standards and are operating effectively and efficiently; resolves escalated claims/operations issues.
Evaluates the provider network to ensure appropriate access for membership and develops/executes recruitment and network gap plans.
Supports the development and implementation of action plans regarding provider satisfaction results.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires a BA/BS in Business Administration, Healthcare Administration, or a related field.
5 years of experience in a healthcare environment, preferably managed care, with 1 years of leadership/management experience, including experience in network development, provider relations, data analysis, and contracting; or any combination of education and experience, which would provide an equivalent background.
Experience with Medicaid required. Experience with Medicare preferred.
Experience with behavioral health providers and behavioral health services required.
Experience with long term care, ID/DD, foster care and juvenile justice desirable.
Experience analyzing provider data including but not limited to network adequacy reports, claims data assessment, and credentialing reports preferred.
Position requires travel 25%
Valid driver’s license and access to a motor vehicle required.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 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
Title: Manager I Provider Network Management Relations (Nationwide) #127336
Requisition ID: 127336