Vacancy caducado!
Description SHIFT: Day JobSCHEDULE: Full-timeYour 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 Reimbursement AdministratorLocation: Norfolk Preferred or RemoteThe preferred location for this position is Norfolk VA, at the Concourse
location (5800 Northhampton Blvd) (If are you within 60 miles of office will be
required to work in-office). This position does offer the work
from home option anywhere within the US.The Provider Reimbursement Administrator 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.
Trains customer service staff
on system issues.
Works with provider contracting
staff when new/modified reimbursement contracts are needed.
This is a full-time position. Department operates Monday - Friday 7 AM to 6
PM EST, but be able to work any eight hour shift within department hours. Qualifications Qualifications:
BA/BS degree in Health Care Management,
Accounting or Business
2-3 years coding experience in
a health care setting (ICD-10, CPT-4, E&M, HCPCS); or any combination
of education and experience, which would provide an equivalent background.
Experience in health insurance
reimbursement, medical billing, medical coding, auditing.
Requires strong oral and
written communication 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.
Experience with Microsoft
Outlook and Excel.
Preferred
CPC certification strongly
preferred.
Previous experience auditing
professional and/or facility coding preferred.
Experience with Microsoft
Access, PowerPoint strongly preferred.
Anthem, Inc. is ranked as one
of America’s Most Admired Companies among health insurers by Fortune magazine
and is a 2018 Diversity Inc magazine Top 50 Company for Diversity. To learn
more about our company and apply, please visit us at careers.antheminc.com. An
Equal Opportunity Employer/Disability/Veteran.REQNUMBER: PS37793
Vacancy caducado!