Anthem, Inc. Network Education Rep Sr in Richmond, Virginia
SHIFT: Day Job
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.
Location: work from home-nationwide locations will be considered
Network Education Representative Sr.
Supports and maintains current provider network with all Commercial Risk Adjustment through customer service including training, credentialing assistance, claims resolution and advocacy. Develops and provides a standard orientation package for newly contracted providers. Responsible for promoting Commercial Risk Adjustment programs with Anthem’s provider network. Works as subject matter expert with regards to programs and manages all provider issues with regards to CRA programs. Acts as liaison between local provider solutions team, provider network and Commercial Risk Adjustment team. Promotes technology and skills development to improve provider business practices.
Primary duties may include, but are not limited to:
Provides/coordinates provider training for Commercial Risk Adjustment programs claims and billing procedures, contract compliance, medical management, and pharmacy issues.
Promotes provider Commercial Risk Adjustment compliance with local/state/region/federal regulations through provider forums and training opportunities.
Supports the contractual agreements with all providers to ensure compliance with local/state/federal regulations as it pertains to Commercial Risk Adjustment
Facilities provider network by recruiting necessary PCP, Specialist, Ancillary, and Hospital providers and assisting Network Support, Contracting, and Credentialing associates to credential and maintain accurate provider contract data.
Provides support for state level leaders in improving provider participation in Commercial Risk Adjustment programs
Responsible for monitoring state level programs
Builds strategies unique to markets to help improve Risk Adjustment processes
Provides leadership in the development, implementation and evaluation of provider operations, contracting and issue resolution strategies.
Mentors, coaches and trains lower level staff.
Reviews state and national programs, trends and literature regarding provider issues and recommend appropriate strategies.
4 years experience; or any combination of education and experience, which would provide an equivalent background.
Ideal candidate will possess excellent communication skills.
Prior experience dealing with provider groups and/or hospital systems 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. 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.