Network Relations Consultant

Description SHIFT: Day JobSCHEDULE: Full-timeYour Talent. Our Vision. At Beacon Health Options, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.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: Must be in the state of California – 100% RemotePrimary 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 provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution.+ May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.+ Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.+ May participation in Joint Operation Committees (JOC) of larger provider groups.+ Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.+ Conducts seminars to support the understanding of managed care policies and procedures. Identifies network access and deficiencies and develops recruitment and contracting strategies.+ Coordinates and conducts provider training including developing and distributing provider relations materials.+ Responsible for providing quality, accessible and comprehensive service to the company’s provider community.+ 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. Qualifications Minimum Qualification:+ Requires a Bachelor’s degree and a minimum of 3 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.If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a ‘sensitive position’ work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance. REQNUMBER: PS65173-US