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Anthem, Inc. Provider Reimburse Admin /Senior in Indianapolis, Indiana

Description

SHIFT: Day Job

SCHEDULE: Full-time

our 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 or Admin Sr.

Please Note: This position may be filled at either the Provider Reimbursement Administrator or Provider Reimbursement Administrator Sr. level. Manager will determine level based upon the selected applicant’s skill set relative to the qualifications listed for this position. Remote opportunity available.

The Provider Reimbursement Administrator/Sr. 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.

Qualifications

Provider Reimbursement Administrator:

  • Requires a BA/BS degree; 2-3 years related experience; or any combination of education and experience, which would provide an equivalent background.

  • Medicare, Medicaid Commercial business products knowledge/experience a plus.

  • WGS and FACETS experience preferred.

  • American Academy of Professional Coders (AAPC) CPC Medical coding certification required. CEMC, CPMA preferred.

  • American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P preferred.

Provider Reimbursement Administrator Senior:

  • Requires a BA/BS degree; 4-6 years related experience; or any combination of education and experience, which would provide an equivalent background.

  • Medicare, Medicaid Commercial business products knowledge/experience a plus.

  • WGS and FACETS experience preferred.

  • American Academy of Professional Coders (AAPC) CPC Medical coding certification required. CEMC, CPMA preferred.

  • American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 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.

REQNUMBER: PS37526-US

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