Job Details

ID #4517203
Estado Kentucky
Ciudad Shelbyville
Full-time
Salario USD TBD TBD
Fuente Anthem, Inc.
Showed 2020-08-05
Fecha 2020-08-06
Fecha tope 2020-10-05
Categoría Etcétera
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Provider Reimburse Admin

Kentucky, Shelbyville 00000 Shelbyville USA

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!

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