Network Relations Specialist / Consultant Sr. /Consultant Mgr. (Job Family)

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: Remote (Must be located within commutable distance to New York City, NY.) Develops and maintains positive relationships with providers, facilities, and their billing and office staff.

Researches and facilitates resolution of provider and facility-related concerns including but not limited to billing and provider file updates.

Primary duties may include, but are not limited to: Network Relations Specialist Works with MBUs operational departments to address provider grievances and service issues.

Provides explanations to providers regarding contract compliance, company procedures and policies, etc.

Recruits, orients and provides high quality service to providers.

Participates in the identification of sufficient number and location of providers to meet area needs.

Assists Contract Management group during contract negotiation by conducting some analysis and obtaining information.

Develops and enhances training programs for providers.

Conducts provider seminars and presentations on company networks, business operations, procedures and protocols.

Functions as a high level technical resource to resolve or facilitate complex provider issues.

Develops new provider programs and addresses major issues related to systems, customer service issues, new network implementation, etc.

Instructs, trains, directs and checks the work of others.

Network Relations Consultant Sr 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.

Network Relations Consult Manager Responsible for supporting the day-to-day overseeing of the Network Relations Consultants.

As a knowledge and resource expert, handles escalated provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution.

Identifies deficiencies and recommends corrective actions.

Identifies and reports on provider utilization patterns which have a direct impact on the quality of service delivery.

Ensures Network Relations Consultants are meeting provider visit requirements.

Attends provider meetings as needed.

Monitors department metrics, provider assignments.

Oversees daily activities and provides feedback to manager on performance management, day-to-day training, guidance, and workflow.

Leads and facilitates team meetings.

Serves as subject matter expert who may be assigned major projects within the department.

Qualifications Network Relations Specialist Minimum Qualifications Requires a BA/BS degree and a minimum of 3 years experience as Network Services Specialist or as a Trainer; or any combination of education and experience, which would provide an equivalent background.

Travel may be required Network Relations Consult Sr Minimum Qualifications Requires a Bachelor’s degree and a minimum of 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.

Network Relations Consultant Manager Minimum Qualifications Requires a Bachelor’s degree and a minimum of 7 years of network relations/provider relations and leadership experience; or any combination of education and experience, which would provide an equivalent background.

Some travel may be required.

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.

The health of our associates and communities is a top priority for Anthem.

We require all new candidates to become vaccinated against Covid-19.

All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification.

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.

Anthem, Inc.

has been named as a Fortune 100 Best Companies to Work For, is ranked as one of the 2020 Worlds Most Admired Companies among health insurers by Fortune magazine, and a 2020 Americas 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 abilityicareerhelp.com for assistance.

REQNUMBER: PS63599-US