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Anthem, Inc. Provider Reimburse Admin or Sr. Job Family - PS34580 in Upland, California

Provider Reimburse Admin or Sr. Job Family - PS34580

Location: Norfolk, Virginia, United States

New

Requisition #: PS34580

Post Date: 1 day 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 Reimburse Admin or Sr. Job Family – In the Office of Norfolk, VA preferred but can be remote within 50 miles from any Anthem office locations.

Please Note: This position may be filled at either the Provider Reimburse Admin or Provider Reimburse Admin Sr. level. Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.

Provider Reimburse Admin:

Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Interpret and apply National Uniform Billing Compliance rules, guidelines, laws and industry trends to support provider education initiatives. Proactively address cost efficiencies and compliance requirements in support of provider education opportunities. 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.

•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 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 as needed.

Provider Reimburse Admin Sr.:

Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Serves as subject matter expert regarding reimbursement policies, edits, and coding conventions. Primary duties may include, but are not limited to:

•Works with vendors and enterprise teams to develop enterprise reimbursement policies, and provider education opportunities to ensure policies and edits do not conflict with Federal and state mandates.

•Works with other departments on claims adjudication workflow development and business process improvements.

•May lead the full range of provider reimbursement activities for a state(s).

•Leads projects related to provider reimbursement initiatives.

•Serves as a mentor to less experienced administrators.

Provider Reimburse Admin

•Requires a BA/BS degree in Health Care Management, Accounting or Business and a minimum of 23 years’ related experience; or any combination of education and experience, which would provide an equivalent background.

•CPC certification required.

•Experience in health insurance reimbursement, medical billing, medical coding, auditing, or health data analytics preferred.

•Requires strong oral and written communication skills, excellent analytical and problem solving skills, strong decision making skills, ability to manage multiple tasks in a demanding work environment, appreciation of cultural diversity and sensitivity towards target membership population, high energy level, self-motivating and able to handle several projects at a time.

•Proficiency with MS Outlook, Word and Excel required.

•Experience with MS Access strongly preferred.

Provider Reimburse Admin Sr.

•Requires a BA/BS degree in Health Care Management, Accounting or Business and a minimum of 4-6 years’ related experience; or any combination of education and experience, which would provide an equivalent background.

•CPC certification required.

•Requires experience in analysis in health care utilization, clinical or managed care environment.

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

•Requires strong oral and written communication skills, excellent analytical and problem solving skills, strong decision making skills, ability to manage multiple tasks in a demanding work environment, appreciation of cultural diversity and sensitivity towards target membership population, high energy level, self-motivating and able to handle several projects at a time.

•Proficiency with MS Outlook, Word and Excel required.

•Experience with MS Access 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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