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Anthem, Inc. Provider Reimbursement Admin-PS33703 in Newbury Park, California

Provider Reimbursement Admin-PS33703

Location: United States

New

Requisition #: PS33703

Post Date: 4 days ago

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.

Provider Reimbursement Admin-Remote within 50 commuting miles to any Anthem office

Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.

Primary duties may include, but are not limited to:

  • Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducts clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.

  • Translates medical policies into reimbursement rules.

  • Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.

  • Coordinates research and responds to system inquiries and appeals.

  • Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.

  • Performs pre-adjudication claims reviews to ensure proper coding was used.

  • Prepares correspondence to providers regarding coding and fee schedule updates.

  • Trains customer service staff on system issues.

  • Works with provider contracting staff when new/modified reimbursement contracts are needed.

Requires:

  • BA/BS degree, preferably in Health Care Management, Accounting or Business

  • 2-3 years coding experience in a health care setting (ICD-10, CPT-4, E&M, HCPCS)

or any combination of education and experience, which would provide an equivalent background.

  • Experience in health insurance reimbursement, medical billing, medical coding, auditing.

  • Requires strong oral and written communication skills.

  • Ability to manage multiple tasks in a demanding work environment.

  • High energy level, self-motivating and able to handle several projects at a time.

  • Experience with Microsoft Outlook and Excel.

  • RN preferred

Preferred skill sets :

  • CPC certification strongly preferred.

  • Previous experience auditing professional and/or facility coding preferred.

-Medicare, Medicaid, and Commercial business products knowledge/experience a plus.

  • WGS and FACETS experience preferred.

  • Experience with Microsoft Access, PowerPoint strongly preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and

is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit

us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

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