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Provider Network Relations Con...


Job Summary

Beaumont, TX
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Provider Network Relations Consultant (Claims and Provider Relations experience needed) - Beaumon...

About the Job

Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it's a powerful combination. It's 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.

The Network Relations Consultant develops and maintains positive relationships with hospitals and develops strategies for recruitment and contracting.

Primary duties may include, but are not limited to:

-Develops and maintains positive relationships with the hospital and physician community by periodic on-site visits, communicating administrative or programmatic changes and facilitating the resolution of issues..

-Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.

-Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.

-Conducts seminars to support the understanding of managed care, policies and procedures.

-Identifies network access and deficiencies and develops recruitment and contracting strategies.

-Coordinates and conducts training.


Requires a BA/BS degree; 3 years of related experience (provider relations, network management, provider customer service); prior negotiation experience; or any combination of education and experience, which would provide an equivalent background.

Additional Requirements:

-Computer proficiency with MS Word and Excel

-comprehensive claims processing experience

-strong critical thinking skills and problem solving skills are a must

We are looking for an outgoing person who enjoys face-to- face interaction on a daily basis.

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.antheminc.com/careers. EOE.M/F/Disability/Veteran.


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