Vacancy expired!
Provider Reimbursement Admin Sr. - remote PS27757Location: United StatesNewRequisition #: PS27757Your 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 atone of America's leading health benefits companies and a Fortune Top 50 Company.Provider Reimbursement Admin Sr.Open to most locations - manager may consider a remote arrangementThe Provider Reimbursement Admin Sr. ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria for Implementation/ Migration Projects. May serve as subject matter expert regarding reimbursement policies, edits, and coding conventions.Primary duties may include, but are not limited to:
Performs system configuration by reviewing 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.
Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring 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.
Works with provider contracting staff when new/modified reimbursement contracts are needed.
Requires a BA/BS degree; 4-6 years related experience; or any combination ofeducation and experience, which would provide an equivalent background.FACETS NetworX Pricer configuration experience required.Access experience required; the ability to query and build reports.Experience facilitating meetings preferred.Anthem, Inc. is ranked as one of America’sMost Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
