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Network Management Representative

Anthem Blue Cross & Blue Shield

Anthem Blue Cross & Blue Shield

Washington, DC, USA · Boston, MA, USA · Andover, MA, USA · Woburn, MA, USA · Woburn, MA, USA · Hingham, MA, USA · Hingham, MA, USA · Newton, MA, USA · Wesley Chapel, FL, USA
Posted on Friday, August 11, 2023

Position Title:

Network Management Representative

Job Description:

Network Management Representative

100% Remote- Ideal candidate would reside in the state of Massachusetts.

Monday- Friday 8:30am-5:00pm EST

$500- Sign-On Bonus

A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

The Network Management Representative provides comprehensive services to the member and provider community through researching more complex issues in a call center environment.

How you will make an impact:

  • Serves as point of contact for other internal departments regarding provider issues that may impact provider satisfaction.
  • Researches and resolves the complex provider issues and appeals for prompt resolution.
  • Coordinates prompt claims resolution through direct contact with providers and claims department.
  • May perform periodic provider on-site visits.
  • Provides assistance with policy interpretation.
  • Researches, analyzes and recommends resolution of provider disputes, issues with billing, and other practices.
  • Assists providers with provider demographic changes as appropriate.
  • Responds to provider issues related to billing, pricing, policy, systems and reimbursements.
  • Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery.
  • Determines if providers were paid according to contracted terms.

Minimum Requirements:

  • Requires a High School diploma and a minimum of 3 years of customer service experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

  • Call Center experience preferred.
  • Previous experience working in face-to-face roles, and or retail/call center environment roles preferred.
  • Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred.

Job Level:

Non-Management Non-Exempt

Workshift:

1st Shift (United States of America)

Job Family:

PND > Provider Relationship Account Mgmt

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.