Anthem, Inc. Provider Resolution Director in San Jose, California
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.
Provider Resolution Director
Remote, work from home position
Responsible for developing and maintaining positive provider relationships, dedicated to National Facility/ Ancillary provider groups with total annual spend up to $1B. May also be focused on multiple Facility contracts in one state or across a particular region of the state. Conduct or collaborate on regular on-site and/or virtual/digital visits, communicates administrative and programmatic changes, and facilitates education and the resolution of provider issues.
Serving as a knowledge and resource expert regarding the most complex National Facility/Ancillary provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution. Where the Director is focused on one state or across a particular region of the state, they shall take on a “Senior” role in collaborating with existing resolution staff as well as with their assigned accounts.
Directors will work with internal matrix partners to triage issues and submit work requests. Functions as a high level technical resource to resolve or facilitate complex provider issues, both internally and externally.
Leads (or co-leads) Joint Operation Committees (JOC) of National Facility/ Ancillary provider groups or state-specific or regional accounts, driving the meetings in the discussion of issues and changes, specifically highlighting strategic opportunities.
Provides assistance regarding Annual Satisfaction Surveys and required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues. Coordinates (or collaborates in) communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns. Coordinates (or collaborates in) prompt claims resolution through direct contact with providers, claims, pricing and medical management department. Manages inventory impacting up $500M A/R, conducts claim and trend analysis.
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.
Shall provide mentorship, training, guidance to PRMs.
Up to 25% travel may be required.
Requires a Bachelor's degree and a minimum of 5 years of Provider service experience including 5 years’ experience healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background.
Applicable to Colorado Applicants Only
Annual Salary Range*: $103,920 - $129,9000
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
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.