Provider Reimburse Admin/Provider Reimburse Admin Senior
Company: Anthem, Inc
Location: Rancho Cordova
Posted on: June 15, 2022
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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
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