Anthem Network Management Consultant / Consultant Sr - Atlanta or Columbus, GA - 131227 in Atlanta, Georgia

/Your Talent. Our Vision./AtBlue Cross Blue Shield of Georgia, a proud member of the Anthem, Inc. family of companies, 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 willdrive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve.

Network Management Consultant

Provides provider relations/network management consulting support to complex, high profile provider organizations. Serves as technical resource and mentor to other consultants. Primary duties may include, but are not limited to: Develops network recruitment and retention strategies to ensure the retention and maintenance of high quality contracted providers. Conducts negotiations and leads contracting efforts with complex, high profile provider organizations to build and maintain a cost effective, accessible provider network. Identifies, researches and analyzes economic and professional provider practice patterns to develop recommendations for improvements. Consults with, educates and trains providers on innovative alternative reimbursement programs. Conducts seminars to support the understanding of managed care and BCBS policies and procedures. Participates in network expansion efforts to recruit new physician specialties or large physician groups. Researches, analyzes and recommends resolution for contract and reimbursement disputes, non-routine claim issues, billing questions and other practices.

Network Management Consultant Sr.

Serves as technical resource, trainer and mentor to other consultants and contracting staff members. Provides provider relations and/or network management consulting support to complex, and/or large high profile provider organizations. Primary duties may include, but are not limited to: Provides guidance regarding resolution of issues that require the intervention of the Provider Engagement and Contracting Department. Identifies and facilitates process improvement projects to improve network provider's experience, to reduce provider abrasion and to reduce costs. Serves on inter-departmental committees and project teams to assist with root cause analysis of provider issues, and communicates positive outcomes/solutions to provider issues/concerns. Develops and maintains policies and procedures and provides training to team members. Acts as department lead in manager's absence. Develops and maintains positive relationships with the provider community by conducting routine and issue-based on-site visits, communicating administrative or programmatic changes and facilitating the resolution of provider issues. Researches, analyzes and recommends resolution for contract and reimbursement disputes, non-routine claim issues, billing questions and other practices. Conducts seminars to support the understanding of managed care and BCBS policies and procedures. Assists with network recruitment and retention strategies to ensure the retention and maintenance of high quality contracted providers. Participates in large and/or complex network expansion efforts to recruit new physician specialties or large physician groups.

Please note: This position can sit in either the Atlanta, GA or Columbus, GA Anthem office.

Network Management Consultant

Requires a BA/BS degree; 3-5 years experience in provider network management, utilization management or other health care field; or any combination of education and experience, which would provide an equivalent background.

Excellent oral and written communication skills preferred.

Network Management Consultant Sr.

Requires a BA/BS degree in business, health administration or related field; 5-7 years experience in provider network management, utilization management or related health care field; or any combination of education and experience, which would provide an equivalent background. Excellent oral and written communication skills preferred.

Please note: This position may be filled at either the Network Management Consultant or Consultant Sr. level. The Hiring Manager will determine level based upon the selected applicant's skillset relative to the qualifications listed for this position.

//

*/ / / 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: Network Management Consultant / Consultant Sr - Atlanta or Columbus, GA - 131227

Location: GA-Atlanta

Other Locations: GA-Columbus

Requisition ID: 131227