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Provider Network Mgr I  (Contracting/Negotiation)  -  #12301 (Iselin, NJ Location - OR Northeast remote) in Woodbridge Township, NJ at Anthem, Inc.

Date Posted: 1/10/2019

Job Snapshot

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.
Develops the provider network through contract negotiations, relationship development, and servicing.
Primary focus of this role is contracting and negotiating contract terms. Typically works with complex providers which may include, but are not limited to, ancillary and hospital providers, practice groups, 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.
Primary 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.
  • Provider claim project review for submission to Claims.
•         Requires a BA/BS degree; at least 2 years’ experience in contracting and provider servicing or any combination of education and experience which would provide an equivalent background.  
•         Requires 10-15% travel; ordinarily car travel within the State of New Jersey. 
•         Requires proficiency in Microsoft Office applications. 
Please note, we currently have one opening for this position and preferred location is:  Iselin, NJ at 101 Wood Avenue South.  However,  will consider a remote position within the Northeast area for ideal candidate. 
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 An Equal Opportunity Employer/Disability/Veteran