Provider Reimburse Admin

Company: Anthem, Inc
Location: Wilmington
Posted on: March 28, 2020

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, Wilmington , Provider Reimburse Admin, Administration, Clerical , Wilmington, Delaware