Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, its a powerful combination. Its the foundation upon which were 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.

For more than 30 years, Beacon Health Options has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 37 million people across all 50 states. At Beacon, our mission is to help people live their lives to the fullest potential. Beacon offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

Location: Applicants who reside in surrounding area of Beaverton, OR or within 1-hour commute to co-located site.

Work Hours: 8:30AM 5:00PM PST.

The Network Relations Consult Sr directs the activities related to the development and maintenance of the company's physician and provider delivery system through the provider relations representatives.

Primary duties may include, but are not limited to:

* Develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.
* Serving 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.
* May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
* Functions as a high-level technical resource to resolve or facilitate complex provider issues.
* Coordinates Joint Operation Committees (JOC) of larger provider groups, driving the meetings in the discussion of issues and changes.
* Provide assistance regarding 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 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.
* Tracks and conduct provider refresher training.
* Researches issues that may impact future provider negotiations or jeopardize network retention.

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Qualifications

Requires a Bachelor's degree; 5 years of customer service experience including 2 years experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background. Travel may be required.

AnEqualOpportunityEmployer/Disability/Veteran