Creates and manages contract templates used across the enterprise to ensure consistency and compliance with all legislative and regulatory requirements. This position will be supporting Anthem Blue Cross of California.
How you will make an impact:
Supports/assists Network Directors/Sr. Managers on major health systems renewals with the highest spend, most complexity in State of CA. Provider spend ranging $2 B - $5 B.
Acts as a liaison between Network Directors/Sr. Managers internal supporting departments PE, HE, CCU, etc. and externally.
Provides contract support, documentation assistance and review on all product lines (Commercial, Medicare, Medicaid).
Supports COC initiatives and leads project work impacting business unit.
Facilitates follow up with PE/AR/PIR/ Special Projects Teams on provider issues.
Attends and provides input at Medicare & Commercial Policy "Greenlighting" review sessions.
Provides Termination Management support, attends weekly termination meetings, facilities communication, etc. for all product lines.
Supports Network Directors/ Sr. Managers with system affiliated HMO fix items and PPAC representation as needed.
Go-to resource for Network Directors/Sr. Managers, interfaces with Medical Management and Sales as needed.
Creates common contract templates for various provider groups to be used throughout the enterprise.
Works closely with Legal and provider contracting management to ensure that contracts meet all federal, state and regulatory requirements.
Recommends language changes and use of alternative or exception language approved for specific uses.
Reviews contract language in response to RFPs, audits, and legal clarifications.
Makes recommendations to contract modifications and presents to governing committee for approval.
Works with contract negotiators to identify areas where push-back is appropriate and helps to educate contract negotiators on contract language impacts.
Review contracts to ensure that contract terms and language can be implemented appropriately.
Researches and quantifies impact to contract modifications.
Maintains tracking software to assist in reporting and responding to key leadership, providers, and consumers.
Develops tools to assist contract negotiators in negotiating effective contracts.
Requires a BA/BS degree in a related field and a minimum of 3 years related experience with contract language, contract development, negotiation, and/or administration; or any combination of education and experience, which would provide an equivalent background.
Basic understanding of Health Insurance is strongly preferred.
Managed Care experience is strongly preferred.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
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.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates 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.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.