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Provider Reimburse Admin/Admin Sr

Company: Anthem, Inc
Location: Modesto
Posted on: January 14, 2020

Job Description:

Provider Reimburse Admin/Admin Sr (PS32079)Location: Virginia, United StatesRequisition #: PS32079Post Date: Dec 31, 2019Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were 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.This position is open to any Anthem facility, and also may consider a remote arrangement (VA, IN, GA, or NY preferred).Provider Reimbursement Admin Sr:Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Serves as subject matter expert regarding reimbursement policies, edits, and coding conventions.Primary duties may include, but are not limited to:

  • Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring policies and edits do not conflict with Federal and state mandates.
  • Works with other departments on claims adjudication workflow development and business process improvements.
  • May lead the full range of provider reimbursement activities for a state(s).
  • Leads projects related to provider reimbursement initiatives.
  • Serves as a mentor to less experienced associates.Provider Reimbursement 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.This position is posted as a job family and the selected candidate will be placed into the level commensurate with their education and experienceProvider Reimbursement Admin Sr:Requires a BA/BS degree; 4+ years Facets NetworX pricing configuration experience; or any combination of education and experience, which would provide an equivalent background.The following are skills and experience that are a must have for this position.
      • Attend meetings and speak on Facets NetworX pricing configuration or alternatives
      • Train team on Facets NetworX pricing configuration and processes
      • Research complex Facets NetworX pricing configuration and inquiries
      • Develop Facets NetworX pricing designs for new pricing methodologies
      • Approve/disapprove contracts in Emptoris (pre-executed contracts), type up Contract Configuration Analysis form if required to clarify intentThe following are preferences for this position
        • Know how to run complex Access queries
        • Backend updates to Facets via Access
        • Ability to migrate configuration from test accounts to other test accounts and then to production
        • Know rate manager/winstrat (if exists in market)Provider Reimbursement Admin:Requires a BA/BS degree; 2+ years of Facets experience; or any combination of education and experience, which would provide an equivalent background. Facets NetworX experience preferred.Anthem , Inc. is ranked as one of Americas 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 An Equal Opportunity Employer/Disability/Veteran.

Keywords: Anthem, Inc, Modesto , Provider Reimburse Admin/Admin Sr, Administration, Clerical , Modesto, California

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