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Provider Contract Spec Sr / Provider Contract Spec (job family)  (Onsite Atlanta, GA ) in Atlanta, GA at Anthem, Inc.

Date Posted: 10/13/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Atlanta, GA
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    10/13/2018

Job Description

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.
 
Provider Contract Specialist
Responsible for coordinating the process for new and existing providers 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.
 
Provider Contract Specialist SR
Functions with the expertise in managing negotiated pricing loads. Responsible for coordinating the process for more complex pricing arrangements involving 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. Must possess critical thinking skills, have a proven strong eye for detail and a focus on quality.

 
Provider Contract Specialist
Requires a H.S. diploma; at least 2 years’ experience with provider contracts, plan procedures, and policies; or any combination of education and experience, which would provide an equivalent background.
 
Provider Contract Specialist SR
Requires a H.S. diploma; at least 5 years’ experience with provider contracts, plan procedures, and policies; or any combination of education and experience, which would provide an equivalent background.
 
Preferred skills and experience for these positions are as following:
 
•         Excel – intermediate level
•         Microsoft – intermediate level
•         Strong Keyboard skills
•         Strong verbal and written communication skills
  • Data Management or customer service
  • Contract Negotiation
Please note,  this position must be located on site at our 4170 Ashford Dunwoody, Atlanta, GA location;  this is NOT a remote position
 
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran