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Anthem, Inc. Provider Experience Director I in Bristol, Tennessee

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.

The Provider Experience Director I is responsible for:

  • Developing and maintaining positive provider relationships, dedicated to National Facility/ Ancillary provider groups with total annual spend up to $1B.

  • May also be focused on multiple Facility contracts in one state or across a particular region of the state.

  • Conduct or collaborate on regular on-site and/or virtual/digital visits, communicates administrative and programmatic changes, and facilitates education and the resolution of provider issues.

  • Serving as a knowledge and resource expert regarding the most complex National Facility/Ancillary provider issues impacting provider satisfaction, researches and resolves the most complex provider issues and appeals for prompt resolution.

  • Where the individual is focused on one state or across a particular region of the state, that individual shall take on a “Senior” role in collaborating with existing PE staff as well as with their assigned accounts.

  • They will work with internal matrix partners to triage issues and submit work requests.

  • Expected to recommend, support and coordinate tradeable amendments on Platinum National Facility /Ancillary groups or multiple Platinum groups locally/regionally.

  • Functions as a high level technical resource to resolve or facilitate complex provider issues, both internally and externally.

  • Leads (or co-leads) Joint Operation Committees (JOC) of National Facility/ Ancillary provider groups or state-specific or regional accounts, driving the meetings in the discussion of issues and changes, specifically highlighting strategic opportunities.

  • Facilitates Annual Provider Satisfaction Surveys and required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues.

  • Coordinates (or collaborates in) communications process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.

  • Provider Manual updates/maintenance. Coordinates (or collaborates in) 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.

  • May organize and execute external Provider Townhalls/Seminars and attend State Association conferences (e.g.: MGMA, AFP, AAP, HFMA).

  • Researches issues that may impact future provider negotiations or jeopardize network retention.

  • Shall provide mentorship, training, guidance to PEMs/PECs.

Qualifications

Requirements:

  • Bachelor's degree and a minimum of 5 years of Provider service experience including 5 years’ experience healthcare or provider environment; or any combination of education and experience, which would provide an equivalent background. 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. 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: PS54467-Bristol-Bristol

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