Provider Network Manager I or II (Medicare)

Anthem

(Wallingford, Connecticut)
Full Time Travel Required
Job Posting Details
About Anthem
At Anthem, Inc., we believe that our health connects us all. So we focus on being a valued health partner and delivering quality products and services that give members access to the care they need. With more than 67 million people served by our affiliated companies including approximately 37 million enrolled in our family of health plans, we can make a real difference to meet the needs of our diverse customers.
Summary
This Provider Network Manager position supports the Medicare East Region and is responsible for developing and enhancing the Medicare provider network through contract negotiations, relationship development, and servicing. Primary duties may include, but are not limited to:
Responsibilities
• Provides support and acts as the primary liaison with key provider groups that participate in Anthem’s Medicare Advantage Enhanced Personal Health Care Program. • Collaborates with various internal departments to effectively implement and manage provider collaboration risk arrangements. • Serves as a subject matter expert in Medicare for the Anthem plan and collaborates with the provider contractors and provider relations representatives to meet provider service needs. • Participates in strategy development of the Medicare network and market expansion initiatives. • Oversees provider education activities related to Anthem’s Medicare products, including development of presentations for orientations and education. May collaborate with the various internal teams such as Payment Innovations, Sales, Quality and Provider Relations in making presentations to key provider groups. • Recommends and drafts provider communications relative to health plan policies and procedures for Anthem’s Medicare products. • Coordinates processes pertaining to contract implementation and maintenance. • May work on cross-functional projects requiring collaboration with other key areas. • May perform special projects.
Ideal Candidate
• Requires a BA/BS degree; • 2 years (level I) or 3-5 years (level II) experience in contracting, provider relations, provider servicing; or any combination of education and experience, which would provide an equivalent background. • Experience must have been from the health care/managed care industry. • Experience in developing provider networks through contract negotiations, relationship development and servicing is required, as well as resolving complex provider issues. • Experience with Medicare contracting and/or reimbursement methodologies is preferred. • Proficiency in MS Excel and PowerPoint is preferred. • Will require travel in the assigned territory at least 20-30% of the time with little to no overnight stay. Travel could be anywhere within the assigned state/territory to include metro as well as rural areas.

Questions

Answered by on
This question has not been answered
Answered by on

There are no answered questions, sign up or login to ask a question

Want to see jobs that are matched to you?

DreamHire recommends you jobs that fit your
skills, experiences, career goals, and more.