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Provider Reimburse Admin - PS27054Location: United StatesNewRequisition #: PS27054YourTalent. 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 thefuture 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.The Provider Reimburse Admin Ensures
accurate adjudication of claims, by translating medical policies, reimbursement
policies, and clinical editing policies into effective and accurate
reimbursement criteria. Must be able to successfully perform all the
duties of the Provider Reimburse Admin .Primary duties may include, but are not limited
to:
Reviews company specific, CMS specific, andcompetitor specific medical policies, reimbursement policies, and editingrules, as well as conducts clinical research, data analysis, and identificationof legislative mandates to support draft development and/or revision ofenterprise reimbursement policy.
Translates medical policies into reimbursementrules.
Performs CPT/HCPCS code and fee schedule updates,analyzing each new code for coverage, policy, reimbursement development, andimplications for system edits.
Coordinates research and responds to systeminquiries and appeals.
Conducts research of claims systems and systemedits to identify adjudication issues and to audit claims adjudication foraccuracy.
Performs pre-adjudication claims reviews toensure proper coding was used.
Prepares correspondence to providers regardingcoding and fee schedule updates.
Trains customer service staff on system issues.
Works with provider contracting staff when new/modifiedreimbursement contracts are needed.
Qualifications:
Requires a BA/BS degree; 2-3 years relatedexperience; or any combination of education and experience, which would providean equivalent background.
CPC Certification Required
Medical Auditing Experience Preferred
Nursing License Preferred.
Anthem, Inc. is ranked as one of America’s MostAdmired Companies among health insurers by Fortune magazine and is a 2018DiversityInc magazine Top 50 Company for Diversity. To learn more about ourcompany and apply, please visit us at careers.antheminc.com. An EqualOpportunity Employer/Disability/Veteran.
