Select your country: United States Canada Deutschland

Network Management Rep I/II/Sr. - Any Anthem PS9860 - Lynchburg, VA #5330555


Company: Anthem

Date: 08/09/2018

Category: Insurance

City: Lynchburg, VA

Network Management Rep I/II/Sr. - Any Anthem PS9860


New


Location: United States


Field: Provider Network Management


Requisition #: PS9860


Post Date: 20 hours ago


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.


Network Management Rep I


Provides comprehensive services to the provider community, supports contracting activities and as needed, assists with cost of care initiatives. Primary duties include, but are not limited to:


  • Receives inbound inquiries from providers which may include requests for an application and agreement, questions about the provider contract, demographic changes, etc.


  • Develops, maintains, and enhances relations with providers to foster cooperative business relationships.


  • Maintains clear lines of communication.


  • Maintains provider log for new requests.


  • Submits and routes complete applications for loading.


  • Gathers credentialing information and processes through credentialing.


  • Validates participation criteria for non-credentialed providers.


  • Assists providers with provider demographic changes and routes as appropriate.


  • Manages department Shared Email/voicemail as appropriate.


  • Distributes welcome letter/reference materials to providers as appropriate.


  • Responds to urgent/escalated requests, as necessary.


  • Researches, analyzes and recommends resolution for provider disputes and identifies training needs as appropriate.


  • Assists with audits as needed in a timely manner.


  • Provides support for special projects and prioritizes workload as needed.

Network Management Rep II


Provides comprehensive services to the provider community through researching more complex provider issues.


Responsible for all of the requirements of the Network Management Rep I PLUS otherprimary duties may include, but are not limited to:


  • Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction.


  • Researches and resolves the more complex provider issues and appeals for prompt resolution.


  • Responds to provider issues and triages as needed to internal resources that evaluate billing, pricing, policy, systems and reimbursement issues.

Network Management Rep Sr.


Provides comprehensive services to the provider community through researching the most complex provider issues. Serves as mentor to new and existing associates.


Responsible for all of the requirements of the Network Management Rep II PLUS other primary duties may include, but are not limited to:


  • Serves as knowledge and resource expert regarding provider issues that may impact provider satisfaction.


  • Researches and resolves the most complex provider issues and appeals for prompt resolution.


  • Coordinates prompt claims resolution through direct contact with providers and claims department.


  • Provides assistance with policy interpretation.


  • Researches, analyzes and recommends resolution of provider disputes as well as issues with billing and other practices.


  • Determines if providers were paid according to contracted terms.


  • Takes the lead on special projects as needed.


  • Assists in developing policies and practices and audits work.


  • Collects data and compiles reports.

Network Management Rep


  • Requires a H.S. diploma; 1-3 years of customer service experience; or any combination of education and experience, which would provide an equivalent background.


  • MS Word and MS Excel required;


  • MS PowerPoint preferred.

Network Management Rep II


  • Requires a H.S. diploma; 3-5 years of administrative assistance experience; one year experience as a Network Representative; or any combination of education and experience, which would provide an equivalent background.


  • MS Word and MS Excel required;


  • MS PowerPoint preferred.

Network Management Rep Sr.


  • Requires a H.S. diploma; 5 years customer service experience; 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.


  • MS Word and MS Excel required;


  • MS PowerPoint preferred.

This position can be filled at Network Management Rep I, II, or Sr. level. The hiring manager will determine the level, based on the candidate's experience and background.


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.


You need to be authorized to apply for this job.

You can find the authorization form on the right panel or below the content area if you use a mobile device. If you don't have an account yet please Sign Up now.



Similar jobs



Select your country: United States Canada Deutschland