Anthem, Inc. Provider Reimburse Administrator Senior in Reston, Virginia
SHIFT: Day Job
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 care companies and a Fortune Top 50 Company.
Location: This is a work-from-home opportunity. Candidates must live within 50 miles of an Anthem facility.
Roles and Responsibilities
The Provider (Coding) Reimburse Admin ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
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. • Translates medical policies into reimbursement rules. Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits. • 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 was used. • Prepares correspondence to providers regarding coding and fee schedule updates. • EM Leveling audit experience. • Experience working in a production environment with short timelines is strongly preferred.
Required Qualifications: • BA/BS degree; 2-3 years related experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications: • A current American Academy of Professional Coders (AAPC) CPC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P coding certification is STRONGLY preferred. • Medicaid Commercial business products knowledge/experience. • WGS and FACETS experience. • E&M experience preferred. • Proficiency in Microsoft Word, Excel, and SharePoint. • Time Management skills are essential. • Must possess strong research skills and perform well independently and in a team setting.
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.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.