Anthem Provider Network Mgr I / II / Sr - (Ancillary Contracting) #12314 (Any Anthem primary location) in Merrillville, Indiana

Provider Network Mgr I / II / Sr - (Ancillary Contracting) #12314 (Any Anthem primary location)

New

Location: United States

Field: Provider Network Management

Requisition #: PS12314

Post Date: Sep 11, 2018

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater 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 benefits companies and a Fortune Top 50 Company.

Manages enterprise ancillary contracting efforts across all lines business to include Medicare and Medicaid, to provide a competitive advantage and deliver competitive cost of care trends. Primary duties include, but are not limited to:

Provider Network Manager I

Responsible for developing the provider network through contract negotiations, relationship development, and servicing.

Primary focus of this role is contracting and negotiating contract terms.

This level typically works with less complex providers which may include, but are not limited to, professional providers, practice groups, small medical groups, providers in less competitive markets, and providers with greater familiarity with managed care concepts.

  • Contracts tend to be more standard and afford less opportunity for customization.

  • Fee schedules are fairly standardized with reimbursement models limited and well-defined.

  • May participate in intradepartmental projects or smaller projects impacting multiple departments.

  • Operates with general supervision, elevating unusual situations to management as required.

Essential duties may include, but are not limited to:

  • Solicits participation in the network and conducts re-contracting efforts as needed.

  • Serves as a communication link between professional providers and the company.

  • Conducts limited negotiations and drafts documents.

  • Assists in preparing financial projections as required.

  • Performs other duties as assigned.

Provider Network Manager II

Responsible for developing the provider network through contract negotiations, relationship development, and servicing.

Primary focus of this role is contracting and negotiating contract terms. This level typically works with more complex providers at least 50% of the time.

  • Complex providers may include, but are not limited to, smaller institutional providers, professional providers with more complex contracts, medical groups, ancillary providers, providers in areas with increased competition or where greater provider education around managed care concepts is required.

  • Contracts may involve non-standard arrangements that require a moderate level of negotiation skills.

  • Fee schedules can be customized.

  • Works with increased independence and requires increased use of judgment and discretion.

  • Serves as resource for lower-leveled consultants.

  • May work on cross-functional projects requiring collaboration with other key areas.

  • May collaborate with sales team in making presentations to employer groups.

Essential duties may include, but are not limited to:

  • Serves as a communication link between professional providers and the company. Conducts more complex negotiations and drafts documents.

  • Assists in preparing financial projections and conducting analysis as required.

  • Performs other duties as assigned.

Provider Network Mgr Sr.

Responsible for developing the provider network through contract negotiations, relationship development, and servicing.

Primary focus of this role is contracting and negotiating contract terms. This level typically works with the most complex providers at least 50% of the time. Complex providers may include, but are not limited to institutional providers, professional providers with complex contracts, medical groups, ancillary providers, providers in areas with strong competition or where greater provider education around managed care concepts is required.

  • Contracts involve non-standard arrangements that require a high level of negotiation skills.

  • Fee schedules are often customized.

  • Serves as key resource for other contracting staff and provides mentoring and on-the-job training and development.

  • May serve as lead over a contracting team engaged in less complex negotiations. Works independently and requires high level of judgment and discretion.

  • May work on cross-functional projects requiring collaboration with other key areas or serve on enterprise projects around network management as needed.

  • May collaborate with sales team in making presentations to employer groups.

Essential duties may include, but are not limited to:

  • Serves as a communication link between providers and the company.

  • Conducts more complex negotiations and drafts documents.

  • May prepare financial projections and conduct analysis as required.

  • Performs other duties as assignedAnEqualOpportunityEmployer/Disability/Veteran

Provider Network Manager I

Requires BA/BS and 2 years’ experience in contracting, provider relations, provider servicing or any combination of education and experience that would afford equivalent competencies.

  • Ancillary contracting experience preferred.

  • Must have strong oral and written communication skills, good analytical skills, and PC skills.

  • Experience in market and network analysis preferred.

  • Experience developing reimbursement and contracting strategies preferred.

  • Requires travel.

Provider Network Manager II

Requires BA/BS, Masters degree preferred, and 3-5 years experience in contracting, provider relations with an emphasis on Medicaid operations, provider servicing or any combination of education and experience that would afford equivalent competencies.

  • Ancillary contracting experience preferred.

  • Must have strong oral and written communication skills, good analytical skills, and PC skills.

  • Experience in market and network analysis preferred

  • Experience developing reimbursement and contracting strategies preferred.

  • Requires travel.

Provider Network Mgr Sr.

Requires BA/BS and 5-7 years experience in contracting, provider relations with an emphasis on Medicaid operations, provider servicing or any combination of education and experience that would afford equivalent competencies

  • Ancillary contracting experience preferred.

  • Experience should include prior contracting experience.

  • Must have exceptional oral and written communication skills, strong analytical skills, and PC skills.

  • Must demonstrate leadership skills

  • Requires travel.

Please note, we currently have one opening for this position and level will be determined upon candidates’ skills, experience and education.

Location preference: This position may be located in any Anthem primary site location. Remote available