Provider Reimbursement Admin
Company: Anthem, Inc
Posted on: March 11, 2020
Provider Reimbursement Admin - PS33667Location: Texas, United
StatesRequisition #: PS33667Post Date: Feb 18, 2020Your Talent. Our
Vision. At Anthem, Inc., its apowerful combination, and the
foundation upon which were creating greater accessto care for our
members, greater value for our customers, and greater healthfor our
communities. Join us and together we will drive the future of
healthcare .Thisis an exceptional opportunity to do innovative work
that means more to you andthose we serve atoneof America's leading
health benefits companies and a Fortune Top 50 Company.Provider
Reimbursement AdminOpen to most Anthem locations; for a remote
arrangement we prefer applicants to be within 50 miles of an Anthem
officeEnsures 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
- Conducts research of claims systems and system edits to
identify adjudication issues and to audit claims adjudication for
- Performs pre-adjudication claims reviews to ensure proper
coding was used.
- Prepares correspondence to providers regarding coding and fee
- Trains customer service staff on system issues.
- Works with provider contracting staff when new/modified
reimbursement contracts are needed.Requires a BA/BS degree; 2-3
years related experience; or any combination of education and
experience, which would provide an equivalent background.
RNpreferred.Coding Certification required: Certified Professional
Coder (CPC),Certified Coding Specialist (CCS),Certified
Professional Medical Auditor (CPMA), or similar/comparable
Certification.Anthem, Inc. is ranked as one of AmericasMost Admired
Companies among health insurers by Fortune magazine and is a 2018
DiversityIncmagazine Top 50 Company for Diversity. To learn more
about our company andapply, please visit us at
careers.antheminc.com. An Equal Opportunity
Keywords: Anthem, Inc, Harrisonburg , Provider Reimbursement Admin, Administration, Clerical , Harrisonburg, Virginia
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