Provider Reimburse Admin
Company: Anthem, Inc
Location: Modesto
Posted on: March 28, 2020
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Job Description:
Provider Reimburse Admin - PS34578Location: Norfolk, Virginia,
United StatesNewRequisition #: PS34578Post Date: 16 hours agoYour
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.Provider Reimburse Admin In the Office of Norfolk, VA
preferred but can be remote within 50 miles from any Anthem
office.The Provider Reimburse Admin Ensures accurate adjudication
of claims, by translating medical policies, 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, 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 as needed.Requires
a BA/BS degree; 2-3 years related experience; or any combination of
education and experience, which would provide an equivalent
background.CPC Certification Required.At least 2-3 years experience
in multi-specialty coding strongly preferred.Proficiency with MS
Outlook, Word and Excel strongly preferred.Experience with MS
Access a plus.Medical Auditing 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 careers.antheminc.com. An Equal
Opportunity Employer/Disability/Veteran.
Keywords: Anthem, Inc, Modesto , Provider Reimburse Admin, Administration, Clerical , Modesto, California
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