Vacancy caducado!
Provider Reimburse AdminLocation: United StatesNewRequisition #: PS26820Your 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.The Provider Reimburse Admin ensures accurate
adjudication of claims, by translating provider contracts, reimbursement
policies, and clinical editing policies into effective and accurate
reimbursement criteria. Must be able to successfully perform all the
duties of the Provider Reimburse Admin.Primary duties may include, but are not limited to:
Reviews company specific, CMSspecific, and competitor specific reimbursement policies, editing rules,coding guidelines, and provider contract language, as well as conductscoding research, data analysis, and identification of legislative mandatesto support draft development and/or revision of enterprise reimbursementpolicy.
Performs CPT/HCPCS code and feeschedule updates, analyzing each new code for coverage, policy,reimbursement development, and implications for system edits.
Coordinates research andresponds to system inquiries and appeals.
Conducts research of claimssystems and system edits to identify adjudication issues and to auditclaims adjudication for accuracy.
Performs pre-adjudication andpost-adjudication claims reviews to ensure proper coding was used.
Prepares correspondence toproviders regarding coding and fee schedule updates.
Trains customer service staff onsystem issues.
Workswith provider contracting staff when new/modified reimbursement contractsare needed.
Qualifications:
Requires a BA/BS degree; 2-3 years related experience;or any combination of education and experience, which would provide anequivalent background.
Coding Certification required Certified ProfessionalCoder (CPC) or Certified Coding Specialist (CCS) required
Certified Professional Medical Auditor Preferred
Anthem, Inc. is ranked as one of America’s MostAdmired Companies among health insurers by Fortune magazine and is a 2018DiversityInc magazine Top 50 Company for Diversity. To learn more about ourcompany and apply, please visit us at careers.antheminc.com. An EqualOpportunity Employer/Disability/Veteran.