Anthem, Inc. Provider Experience Mgr in Cordova, Tennessee
SHIFT: Day Job
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 care companies and a Fortune Top 50 Company.
The Provider Experience Manager is responsible for providing quality, accessible and comprehensive service to the company's provider community. Primary duties may include, but are not limited to:
•Develops and maintains positive provider relationships with provider community by regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.
•Serves as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction; researches and resolves the most complex provider issues and appeals for prompt resolution.
•Attends provider meetings as needed.
•Works with internal matrix partners to triage issues and submit work requests.
•Is assigned higher level, Tier 1/Platinum providers, but will handle Tier 2’s as well.
•Functions as a high-level technical resource to resolve or facilitate complex provider issues.
•Coordinates Joint Operation Committees (JOC) of Tier 1 /Platinum provider groups, driving the meetings in the discussion of issues and changes.
•Provides assistance regarding Annual Provider Satisfaction Surveys and required corrective action plan implementation and monitoring, education, contract questions 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. Organizes and executes external Provider Townhalls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA).
•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.
•Serves as subject matter expert who may be assigned major projects within the department.
•Tracks and conduct provider refresher training. •Researches issues that may impact future provider negotiations or jeopardize network retention. 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. 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 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.
•Requires a Bachelor's degree; 5 years of customer service experience including 2 years of experience as a Provider Relations Rep or Network Management Rep and etc.; or any combination of education and experience, which would provide an equivalent background. Travel may be required. •Travel is required up to 75%, local travel for provider visits. •Contract negotiation skills preferred. •Computer proficiency in Microsoft suite including but not limited to Word, Excel, PowerPoint, Outlook, OneNote and SharePoint. •Claims experience preferred •Behavioral Health knowledge preferred
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 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.