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Anthem, Inc. Provider Reimburse Admin Sr in Manchester, New Hampshire


SHIFT: Day Job

SCHEDULE: Full-time

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.

Norfolk, VA location is preferred, can be remote within 50 miles from any Anthem office.

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 reimbursement, system configuration and ongoing provider education. Proactively address cost efficiencies and compliance requirements. Primary duties may include, but are not limited to:

  • Reviews Anthem specific, CMS specific, and competitor specific medical policies, reimbursement policies, coding guidelines and editing rules, as well as conducts research, data analysis, and provider identification in the development of provider education opportunities.

  • Analyzes and monitors claims data.

  • Perform pre/post payment reviews on providers who continue aberrant billing practices.

  • Interfaces with local Health Plan representatives regarding provider education initiatives.

  • Prepares correspondence to providers regarding correct coding practices.

  • Prepares and presents reports defining observations and recommendations.

  • Leads projects related to provider reimbursement initiatives.

  • Serves as a mentor to less experienced administrators.

  • Performs other duties as assigned.


  • Requires a BA/BS degree in Health Care Management, Accounting or Business and a minimum of 4-6 years coding 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 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.

Applicable to Colorado Applicants Only

  • Annual Salary Range*: $64,595-$80,745

  • Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

    • The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
  • We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. An Equal Opportunity Employer/Disability/Veteran.

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

REQNUMBER: PS45690-Manchester-Manchester