Experience

Anthem

• United States
• Insurance
• 700 & Above Employee

• Provider Contract Specialist

  • Apr 2016 - Present

  Processes standard and non-standard provider contracts and works with internal departments to facilitate new and re-contracting efforts for all networks in a defined health service area. Primary duties may include, but are not limited to: • Conducts formal review of Contracts and Credentialing documents. • Coordinates the approval and issuance of all approved contracts to the appropriate parties with various internal departments such as credentialing, reimbursement and provider database. • Performs basic and in-depth research to determine the legal names of group, reimbursement method required, as well as the status of the provider group at time of request. • Creates boilerplate provider contracts and selects and inserts optional paragraphs/riders as required. • Maintains automated tracking system and maintains status logs. • Maintains related provider group contract files and sets up group for future contract documents. • Will research and administer process for provider group data changes and provider group terminations; prepare and mail all new or re-contracting agreements; and create and maintain all provider files and related documentation.

• Claims Representative III (Health & Dental)

  • Feb 2009 - Apr 2016

  • Key, process and adjust health claims in accordance with claims policies and procedures • Review, analyze and process claims/policies related to events to determine extent of company's liability and entitlement• Research and analyze claims issues• Respond to inquiries, may involve customer/client contact

• Customer Care Representative II

  • Jun 2007 - Feb 2009

  • Was responsible for responding to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims• Researched and analyzed data to address operational challenges and customer service issues• Developed and maintained positive customer relations and coordinated with various functions within the company to ensure customer requests and questions were handled appropriately and in a timely manner• Received and placed follow-up telephone calls / e-mails to answer customer questions