Anthem Inc. Health Insurance Jobs

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Anthem, Inc. Provider Experience Manager in Middletown, New York

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and 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.

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.

This role will be in the newly formed Provider Experience (PE) group in Anthem’s New York region or EmpireBCBS. The team will be reimagining how we deliver service and resolve issues for our valued network partners. Our goal is to improve our relationships with providers through delivering on improved operations and new tools both internally and externally. This team has a strategic value, and we are looking for those who love process improvement, working with associates throughout the enterprise and who can also develop trusted external relationships.

At all levels, these Provider Experience (PE) roles are responsible for developing and maintaining positive provider relationships with large hospitals, health systems and provider groups with total annual spend in excess of several million dollars. Serving as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction, member and client satisfaction and renegotiation hurdles to operational inefficiencies. Works with internal matrix partners to triage issues, prioritize workloads and help escalate critical issues to executive leadership.

NOTE: This position is work from home with the applicant's physical location being within a reasonable commute to any Anthem office in Empire BCBS’s New York Territory.

Provider Experience Consultant (E11)

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 (once safe), by communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues. 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 Facility Providers and Tier 1 or 2 Ambulatory Surgery or Ancillary providers. Researches, analyzes, and recommends resolution for non-routine claim issues, billing questions and other practices. Coordinates communication externally with providers on such issues as administrative and medical policy, other important Anthem initiatives. 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.

Provider Experience Manager (E12)

All responsibilities of a Provider Experience Consultant while working with a larger volume of provider accounts and mostly on Tier 1 provider hospitals. Functions as a high-level technical resource to resolve or facilitate complex provider issues for your own accounts and through mentoring others on the team. Coordinates Joint Operation Committees (JOC) of Tier 1 provider accounts, driving the meetings in the discussion of issues and changes leading to productive outcomes. May help organize and executes external Provider Townhalls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA). Works closely with other teams under global PE Org such as PIR and HART to address claims resolution through direct contact with providers, claims, pricing, and medical management department. Take initiative to set up cross functional work groups to address areas, bringing together SMEs, OE’s or other leaders to root cause issues and create meaningful process improvements.

Provider Experience Manager Sr. (E13)

All responsibilities of a Provider Experience Manager while working with a larger volume of provider accounts and mostly on Tier 1/Premium provider hospitals. Will be responsible for some of our most complex and challenging provider partnership and will assist department Manager and Director on special projects in addition to day to day accounts. May be responsible for monitoring department metrics, provider assignments and oversight of daily activities and provide feedback to manager on performance management, day-to-day training, guidance, and workflow of Provider Experience Consultants and Provider Experience Managers.

Qualifications

Minimum Requirements:

Provider Experience Consultant (E11)

Requires a Bachelor's degree; 3 years of external customer service experience including 2 years of experience working with providers and/or clients; or any combination of education and experience, which would provide an equivalent background.

Provider Experience Manager (E12)

Requires a Bachelor's degree; 5 years of external customer service experience including 2 years of experience working with providers and/or clients; or any combination of education and experience, which would provide an equivalent background.

Provider Experience Manager Sr. (E13)

Requires a Bachelor's degree, but advanced degree preferred; 7 years of external customer service experience including 2 years of experience working with providers and/or clients; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications for all job levels:

  • Knowledge of Commercial, Medicare and Medicaid contract terms and reimbursement types

  • Ability to learn new systems, SharePoint sites, software, etc.

  • Advanced MS Excel skills

  • Ability to adapt and thrive in an evolving workplace with multiple, competing priorities is essential, as well as high ability to learn many technology tools and us them effectively in day-to-day work. Travel within New York may be required once safe and permissible through CDC and/or Anthem HR policies.

    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. 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.

    REQNUMBER: PS57854-2155-Middletown

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