Network Management Consultant Senior

Company: Anthem, Inc.
Location: Baton Rouge
Posted on: September 15, 2020

Job Description:

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 Network Management Consultant Senior 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 with primary focus on Social Determinants of Health, such as food and housing insecurities; 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.

Requires a BA/BS degree in business, health administration or related field; 5-7 years of 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.

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.

Keywords: Anthem, Inc., Baton Rouge , Network Management Consultant Senior, Other , Baton Rouge, Louisiana