Provider Pay Reconsider Analyst I/II- Nationwide- PS27237

Provider Pay Reconsider Analyst I/II- Nationwide- PS27237

18 Sep 2024
Virginia, Alexandria 00000 Alexandria USA

Provider Pay Reconsider Analyst I/II- Nationwide- PS27237

Vacancy expired!

Provider Pay Reconsider Analyst I/II- Nationwide- PS27237Location: United StatesNewRequisition #: PS27237Your 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 Pay Reconsider Analyst I/IILEVEL 1This position supports the Payment Dispute process across all lines of business and is specifically responsible for the resolution of Provider Payment Reconsideration requests. Primary duties include, but are not limited to:

Reviews and analyzes provider requests to investigate the outcome of claim payment or denial.

Determines the appropriate resolution using strict adherence to internal guidelines, policies, and procedures.

Must work with various departments, when necessary, to determine root cause and appropriate resolution.

Must remediate impacted claims.

LEVEL 2This position supports the Payment Dispute process across all lines of business and is specifically responsible for the resolution of Provider Payment Reconsideration requests. Primary duties include, but are not limited to:

Reviews and analyzes provider requests to investigate the outcome of claim payment or denial.

Determines the appropriate resolution using strict adherence to internal guidelines, policies, and procedures.

Must work with various departments, when necessary, to determine root cause and appropriate resolution.

Must remediate impacted claims.

Responsible to manage Reconsideration escalations and may serve as a liaison between grievances & appeals and /or medical management, legal, service operations and/or other internal departments as appropriate.

AnEqualOpportunityEmployer/Disability/VeteranLEVEL 1

Requires a High school diploma or GED

3 years experience working in claims or customer service, familiarity with medical coding and medical terminology, demonstrated business writing proficiency, understanding of claims process, the company's internal business processes, and internal local technology

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

LEVEL 2

Requires a High school diploma or GED

1 year of Provider Payment Reconsideration Analyst I experience

3 years experience working in claims or customer service, familiarity with root cause remediation, medical coding and medical terminology, demonstrated business writing proficiency, understanding of claims process, the company's internal business processes, and internal local technology

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

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

Related jobs

  • Summary This position is in the National Science Foundation (NSF), Office of the Director (OD), Office of Integrative Activities (OIA). The incumbent serves as a senior expert and advisor to the highest levels of NSF leadership for the use of technology in knowledge management and responds to NSF leadership, staff, and external stakeholders regarding NSF\'s most complex knowledge management challenges. Responsibilities As a Management & Program Analyst (Knowledge Management Technical Advisor), GS-0343-14, you will perform the following duties: Leads the establishment and oversight of NSF institutional vocabulary and data model (ontology) to be used for organizing and tagging knowledge artifacts to prepare the agency for smart search and retrieval and for the implementation of artificial intelligence and data-as-a-service. Serves as the agency authority to create and own the NSF policies and procedures relating to knowledge management & knowledge management technology. Represents top level leadership on complex matters involving knowledge management technology policies and procedures, involving both written and oral presentations. Serves as the project leader for Knowledge Management Technology and advises on technology architecture that accommodates NSF\'s knowledge management needs. The incumbent serves as a senior expert and advisor to the highest levels of NSF leadership for the use of technology in knowledge management and responds to NSF leadership, staff, and external stakeholders regarding NSF\'s most complex knowledge management challenges. Leads cross-functional, NSF-wide teams to build partnerships and develops business rules and requirements for NSF\'s knowledge management program needs. Serves as Contracting Officer Representative and key decision maker overseeing complex contracts critical to knowledge management technology at NSF. Acts as the NSF Liaison and facilitates workflow between subject matter experts, information technology experts, and data analysts of many varieties. Collaborates widely to build a clean, internal, NSF-wide policy database by adding historical and current policies with metadata to the current NSF document repository. Requirements Conditions of Employment You must be a US citizen. Selectee will be required to have a background investigation prior to onboarding. Selectee may be required to serve a 1-year trial/probationary period. Additional Requirements: Time in Grade Requirement: Applicants who have held a General Schedule (GS) position within the last 52 weeks must have 52 weeks of Federal service at the next lower grade/equivalent. You must meet eligibility & qualification requirements within 30 days of the closing date. You must answer all job-related questions in the NSF eRecruit questionnaire & any external assessment that is included. All online applicants must provide a valid email address. If your email address is inaccurate or your mailbox is full/blocked, you may not receive important communication that could affect your consideration for this position. Qualifications To qualify at the GS-14 level, you must have one year of specialized experience equivalent to the GS-13 Level in the federal service performing knowledge management activities for an organization. Examples of relevant knowledge management activities include: developing and implementing knowledge management policies or procedures; defining an organizational knowledge management strategy; researching and recommending technology to support knowledge management activities; defining institutional vocabulary; and providing recommendations to organizational leadership and staff regarding knowledge management tasks and functions. In addition to meeting the specialized experience above. Applicant must also meet the following selective placement factor below: Must possess a current FAC-COR Level II certification or, have completed the FAC-COR Level II (40-hour) training course, and possess one year of experience in order to be certified. One year of relevant experience would include the following: Performing market research, writing statements of work or statements of objectives, drafting independent government cost estimates, reviewing contract deliverables, participating as a subject matter expert on a technical evaluation team. You must submit documentation to confirm that you meet this requirement. Experience refers to paid/unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) & other organizations (e.g., professional; philanthropic; religious; spiritual; community, student, social). Volunteer work helps build critical competencies, knowledge, & skills & can provide valuable training/experience that translates directly to paid work. You will receive credit for all qualifying experience, including volunteer experience. Education Education may enhance skills required for this position; however, no substitution of education for specialized experience may be made at this level. Additional Information Relocation Expenses will not be paid. This is a non-bargaining unit position. It is NSF policy that NSF personnel employed at or IPAs detailed to NSF are not permitted to participate in foreign government talent recruitment programs. Failure to comply with this NSF policy could result in disciplinary action up to & including removal from Federal Service or termination of an IPA assignment & referral to the Office of Inspector General. Foreign Talent Definitions Interagency Career Transition Assistance Program (ICTAP) ICTAP and CTAP provide eligible displaced Federal competitive service employees with selection priority over other candidates for competitive service vacancies. If your agency has notified you in writing that you are a displaced employee eligible for ICTAP or CTAP consideration, you may receive selection priority if: 1) this vacancy is within your ICTAP or CTAP eligibility; 2) you apply under the instructions in this announcement; and 3) you are found well-qualified for this vacancy. To be well-qualified you must meet the following: OPM qualification requirements for the position, all selective factors, where applicable; special OPM approved qualifying conditions for the position; is physically qualified with reasonable accommodation, where appropriate, to satisfactorily perform the duties of the position upon entry; and receives a rating of at least \"Very Good\" on the questionnaire. You must provide proof of eligibility with your application to receive selection priority. Such proof may include a copy of your written notification of ICTAP or CTAP eligibility, or a copy of your separation personnel action form. Additional information regarding ICTAP or CTAP eligibility is available from OPM\'s Career Transition Resources Veteran\'s Preference: If you are entitled to veterans\' preference, you should indicate the type of veterans\' preference you are claiming on your resume. Your veterans\' preference entitlement will be verified by the employing agency. For 5-point veterans\' preference, please provide your DD-214 (Certificate of Release or Discharge from Active Duty), official statement of service from your command if you are currently on active duty, or other official documentation (e.g., documentation of receipt of a campaign badge or expeditionary medal) that proves your military service was performed under honorable conditions. For 10-point veterans\' preference, please submit a Standard Form (SF) 15, Application for 10-Point Veteran Preference, DD-214, and the VA letter or other required documentation as specified on the SF-15. NSF has determined that all of its positions are eligible for telework. Work suitable for telework depends on job duties; therefore, employees must receive approval from their supervisor for telework and have a telework agreement in place. Entering into a telework agreement is voluntary. This announcement may be used to fill like positions in other organizations within the National Science Foundation.

  • Description

  • Description

  • Description

  • Description

  • Operations Analyst I / II - Alexandria

  • Description Responsibilities: We are looking to fill a full-time Information Systems Specialist III (ISS III). Under limited supervision and a high level of judgment required, this advanced technical services position is responsible for the management and troubleshooting of all classrooms\' audiovisual and computing equipment, staff and faculty enterprise applications, including research and proactive maintenance at the assigned college/s. The position will perform complex technical support and administrative functions across the complete range of technologies supported by MCCS Information Technology Services, requiring a vast knowledge of multiple user and server hardware, software, and Software as a Service (SaaS) environments. This position is also responsible for installing, configuring, and maintaining campus specific software and services. The position is required to keep up to date on current computer technology in order to make informed recommendations regarding policy development and improvements and assist in the development of information technology plans for the college, working collaboratively with college employees, the Helpdesk Manager, and MCCS Chief Information Officer.

Job Details

Jocancy Online Job Portal by jobSearchi.