Provider Reimburse Admin/Provider Reimburse Admin Senior

Company: Anthem, Inc
Location: Rancho Cordova
Posted on: June 15, 2022

Job Description:

Description SHIFT: Day JobSCHEDULE: Full-timeBe part of an extraordinary team We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?This position can be filled at the Provider Reimburse Admin or Provider Reimburse Admin Sr. level. The hiring manager will determine the level, based on the candidate's experience and background.Job Title: Provider Reimburse Admin Location: 100% RemoteBuild the Possibilities. Make an extraordinary impact.Ensures accurate adjudication of claims, by translating medical policies and reimbursement policies into effective and accurate reimbursement criteria.How you will make an impact:+ Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, as well as conducts clinical research, data analysis, and identification of legislative mandates to support draft development.+ Performs CPT/HCPCS code and fee schedule updates and analyzes each new code for coverage.+ Coordinates research and responds to system inquiries.+ Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.+ Prepares correspondence to providers regarding coding and fee schedule updates.+ Works with provider contracting staff as needed.Job Title: Provider Reimburse Admin Sr. Location: 100% RemoteBuild the Possibilities. Make an extraordinary impact.Ensures accurate adjudication of claims, by translating medical policies and reimbursement policies into effective and accurate reimbursement criteria. Serves as subject matter expert regarding reimbursement policies.How you will make an impact:+ Works with vendors and enterprise teams to develop and edit department policies ensuring policies and edits do not conflict with Federal and state mandates.+ Works with other departments on claims adjudication workflow development and business process improvements.+ May lead the full range of provider reimbursement activities for a state(s).+ Leads projects related to provider reimbursement initiatives.+ Serves as a mentor to less experienced administrators.Qualifications Provider Reimburse AdminMinimum Requirements:+ Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background.Preferred Skills, Capabilities and Experiences:+ Implant experience or knowledge preferred.+ Familiarity with coding, insurance claims, and payment methodologies preferred.+ Microsoft Office skills, especially Word, Excel, and Outlook strongly preferred.+ Good communication and organizational skills strongly preferred.Provider Reimburse Admin Sr.Minimum Requirements:+ Requires a BA/BS degree and a minimum of 4 years related experience; or any combination of education and experience, which would provide an equivalent background.Preferred Skills, Capabilities and Experiences:+ Implant experience or knowledge preferred.+ Familiarity with coding, insurance claims, and payment methodologies preferred.+ Microsoft Office skills, especially Word, Excel, and Outlook strongly preferred.+ Good communication and organizational skills strongly preferred. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance. REQNUMBER: PS69733

Keywords: Anthem, Inc, Rancho Cordova , Provider Reimburse Admin/Provider Reimburse Admin Senior, Administration, Clerical , Rancho Cordova, California