Provider Reimburse Admin Sr - Anthem, Inc (Texas)
Description
SHIFT: Day Job
SCHEDULE: Full-time
Your
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
Admin Senior
Ensures accurate adjudication of claims, by
translating medical policies, reimbursement policies, and clinical editing
policies into effective and accurate reimbursement criteria. Interpret and
apply National Uniform Billing Compliance rules, guidelines, laws and industry
trends to support, provider reimbursement, system configuration and ongoing
provider education. Proactively address cost efficiencies and compliance
requirements.
Primary duties may include, but are not limited to:
+ Reviews Anthem specific, CMS specific,
and competitor specific medical policies, reimbursement policies, coding
guidelines and editing rules, as well as conducts research, data analysis,
and provider identification in the development of provider education
opportunities.
+ Analyzes and monitors claims data.
+ Perform pre/post payment reviews on
providers who continue aberrant billing practices.
+ Interfaces with local Health Plan
representatives regarding provider education initiatives.
+ Prepares correspondence to providers
regarding correct coding practices.
+ Prepares and presents reports defining
observations and recommendations.
+ Leads projects related to
provider reimbursement initiatives.
+ Serves as a mentor to less
experienced administrators.
• Performs other duties as
assigned.
This positon may work from any Anthem
location. Can work remotely.
Qualifications
Requirements:
+ Requires a BA/BS degree in Health Care
Management, Accounting or Business and a minimum of 4-6 years coding
experience; or any combination of education and experience, which would
provide an equivalent background.
+ CPC certification required.
+ Experience in health insurance
reimbursement, medical billing, medical coding, auditing, or health data
analytics preferred.
+ Requires strong experience in analysis in
health care utilization, clinical or managed care environment.
+ Previous experience auditing professional
and/or facility coding preferred.
+ Requires strong oral and written
communication skills, excellent analytical and problem solving skills,
strong decision making 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.
Anthem,
Inc. is ranked as one of America’s 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
REQNUMBER: PS42104
* This article was originally published here
