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Provider Reimburse Admin

Company: Anthem, Inc
Location: Placentia
Posted on: December 24, 2019

Job Description:

Provider Reimburse AdminLocation: United StatesNewRequisition #: PS31764Post Date: 1 day agoYour Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which werecreating greater access to care for our members, greater value for ourcustomers, and greater health for our communities. Join us and together wewill drive the future of health care .This is an exceptional opportunity to do innovative work thatmeans more to you and those we serve at one of America's leading healthbenefits companies and a Fortune Top 50 Company.The Provider Reimburse Admin ensures accurateadjudication of claims, by translating provider contracts, reimbursementpolicies, and clinical editing policies into effective and accuratereimbursement criteria. Must be able to successfully perform all theduties of the Provider Reimburse Admin.Primary duties may include, but are not limited to:

  • Reviews company specific, CMS specific, and competitorspecific reimbursement policies, editing rules, coding guidelines, andprovider contract language, as well as conducts coding research, dataanalysis, and identification of legislative mandates to support draftdevelopment and/or revision of enterprise reimbursement policy.
  • 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 inquiriesand appeals.
  • Conducts research of claims systems and system edits toidentify adjudication issues and to audit claims adjudication foraccuracy.
  • Performs pre-adjudication and post-adjudication claimsreviews to ensure proper coding was used.
  • Prepares correspondence to providers regarding codingand fee schedule updates.
  • Trains customer service staff on system issues.
  • Works with provider contracting staff when new/modifiedreimbursement contracts are needed.Qualifications:
    • Requires a BA/BS degree; 2-3 years related experience;or any combination of education and experience, which would provide anequivalent background.
    • Coding Certification required Certified ProfessionalCoder (CPC) or Certified Coding Specialist (CCS) required
    • Certified Professional Medical Auditor PreferredAnthem, Inc. is ranked as one of Americas MostAdmired Companies among health insurers by Fortune magazine and is a 2018DiversityInc magazine Top 50 Company for Diversity. To learn more about ourcompany and apply, please visit us at careers.antheminc.com. An EqualOpportunity Employer/Disability/Veteran.

Keywords: Anthem, Inc, Placentia , Provider Reimburse Admin, Administration, Clerical , Placentia, California

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