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: State of Massachusetts
Must reside within a commutable distance to the Massachusetts Anthem office
Functions with the expertise in managing negotiated pricing loads. The Provider Contract Specialist Manager is responsible for coordinating the process for the most complex pricing arrangements involving facilities or large health systems, or high profile provider groups and/or physician groups tied to large hospital systems joining the network including creating standard contracts for providers as needed.
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.
Requires a H.S. diploma; at least 5 years of experience with provider contracts, plan procedures, and policies; or any combination of education and experience, which would provide an equivalent background.
Must possess critical thinking skills, have a proven strong eye for detail and a focus on quality.
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.