Seeking a position which allows me to demonstrate my potentials to aspire to greater heights where I may utilize my background and experience to provide a level of contributed achievements.
Digital Enrollment of provider contracting
Developed the policy and procedure for the Digital Enrollment within our department
Assisted developing PLM process and provided educational training to the department.
Administer the request for Fee Schedules to providers
Telephonic and application documentation experience for external/Internal
recruitment for contracted/credentialing providers
Develops/Maintain a high level of accuracy and flexibility.
Established structured components in building solid relationship/commitments
throughout Anthem organization.
Serves as point of contact through research, analyzing and recommends resolution of
Understanding and complying practices with policies and procedures.
Provides assistance, identify and provide education to the provider community for
contract questions and non- routine claim issues.
Prepare and execute provider contract for HMO, PPO, POS, EPO and Government programs Experience in facilitating Open Enrollment meetings by participating in Anthem's Open Enrollment Ambassador program Participates in projects to establish and build provider networks to support products that drive cost advantages.
Extensive knowledge of Individual and Commercial Anthem products and benefit
Participates in provider relationship management, provider communication, provider
education and provider contract enrollment
Prepares provider application and supporting documents for credentialing committee review
Prepare and execute provider contracts for network participation
Responsible for providing quality and comprehensive service to the provider
Prepare and distribute orientation documents for newly contracted providers.
Research, analyze and recommend resolutions for provider disputes
Collects data, compiles reports and works on related special projects as assigned.
Assist in Provider Recruitment for networks geared for Exchange, Commercial, and
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