Job Description

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and 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.

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 Experience Consultant (PS47485)

Location:
Waukesha, WI
Green Bay, WI
Eau Claire, WI
Fond du Lac, WI

The Provider Experience Consultant will be responsible for providing quality, accessible and comprehensive service to the company's provider community. Develops and maintains positive provider relationships with provider community via a mixture of email, telephonic and face-to-face outreach, by communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.

Primary duties may include, but are not limited to:
Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction; researches and resolves complex provider issues and appeals for prompt resolution.
Works with internal matrix partners to triage issues and submit work requests.
Assigned to Tier 2 and 3 providers.
Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
Conducts routine outreach to support the understanding of managed care policies and procedures.
Coordinates and conducts provider training including developing and distributing provider relations materials.
Provides assistance regarding Annual Provider Satisfaction Surveys and required corrective action plan implementation and monitoring, education, and non-routine claim issues.
Coordinates communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
Coordinates Provider Manual updates/maintenance.
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.
Researches issues that may impact future provider negotiations or jeopardize network retention.

Qualifications

Requirements
Requires a Bachelor's degree; 3 years of customer service experience including 2 years of experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.
Travel may be required.

Anthem, Inc. is ranked as one of Americas 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. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.