Anthem Vendor Implementation Specialist (United States) #129947 in Woodland Hills, California
/Your Talent. Our Vision./* At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to 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. _ _ _Vendor Implementation Specialist (United States)_ _ _ The Vendor Implementation Specialist takes a lead role in national delegated vendor provider network development, contract negotiations and development, implementations, terminations & de-implementations and Joint Operations Meetings.
Primary duties may include, but are not limited to:
Responsible for on-going operations management, oversight of national vendor delegates, and coordination of contract requirements to ensure contracts meets Anthem’s legal and regulatory standards including, but not limited to, administration and reimbursement parameters.
Responsible for ensuring compliance with all regulatory, CMS, NCQA, state and Federal regulations. Responsible for managing 3rdparty delegated vendor relationships, such as dental, vision and non-emergent transportation, for Medicaid, MMP and Medicare lines of business. Manages complex new vendor and vendor operational enhancement program implementations for multiple states. Operational issue management resolution and problem solving for ongoing relationships, planned initiatives to achieve cost of care savings for a state and/or less complex regional initiatives, ensuring successful Government Business Division delegated vendor management implementations including contract & network development, workflow process development, performance metric development and maintenance. Identifies, resolves and implements operational vendor processes that ensure appropriate vendor payments and data needs for multiple states with similar system platforms, or a state or a less complex regional initiative.
Candidate must be a critical thinker and have the ability to solve problems independently.
BA/BA degree preferred; 3-5 years of provider contracting, provider network development, provider network management, or related experience; or any combination of education and experience, which would provide an equivalent background.
/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2015 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at//antheminc.com/careers//. EOE. M/F/Disability/Veteran.__/
Job Provider Network Management
Title: Vendor Implementation Specialist (United States) #129947
Location: CA-Woodland Hills
Requisition ID: 129947