Description
SHIFT: Day Job
SCHEDULE: Full-time
Provider Contract Specialist Sr
New York, New Jersey, or Connecticut preferred
Be a part of an extraordinary team
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be a part of a larger purpose and evolving, high-performance culture that empowers you to make an impact?
Build the Possibilities. Make an extraordinary impact.
Your Talent. Our Vision. At Anthem, Inc., it's powerful combination, and the foundation upon which we're creating greater access to care for our members., great value for our customers, and great 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.
The Provider Contract Specialist Sr position is responsible for coordinating the process for more complex pricing arrangements involving high profile provider groups and/or physician groups tied to large hospital systems joining the network including creating standard contracts for providers as needed. Functions with the expertise in managing negotiated pricing loads.
Primary duties may include, but are not limited to:
Manage provider update files submitted by delegated provider entities and/or large groups/integrated delivery system.
Prepare the information for timely and accurate submission to the Provider Data Management area.
Ensure updates/changes for existing network providers are interpreted and loaded accurately.
Ensure accurate and timely loading of professional and facility contracts across value based and fee for service agreements for provider solutions.
Works directly with contracting directors and managers to understand what is negotiated and how the negotiated agreement is translated into the company's systems resulting in accurate and timely loading.
Performs internal audit of provider record, ensuring accuracy against rosters.
Serves as the go-to with matrix partners to resolve interpretation issues and ensure timely turnaround.
Serve as local market expert supporting (and managing when necessary) the provider onboarding process and provider updates submitted by provider offices within defined market.
Must possess critical thinking skills, have a proven strong eye for detail and a focus on quality.
Qualifications
Minimum Requirements:
Requires a H.S. diploma and a minimum of 5-years' experience with provider contracts, plan procedures, and policies; or any combination of education and experience, which would provide an equivalent background.
Preferred Requirements:
Microsoft Word, Excel, and Outlook experience preferred
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. 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 Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. 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 age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.
REQNUMBER: PS70129-US
