SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re 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 care companies and a Fortune Top 50 Company.

LOCATION - REMOTE

Coding Provider Reimburse Admin
Ensures 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 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 are needed. 
•    Ensures productivity requirements are met along with ensuring the quality of work.

Qualifications

Minimum Qualifications:
•    The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to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.
•    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 Qualifications:
•    Medicaid, Medicare or Commercial business products knowledge/experience a plus.
•    FACETS experience preferred.
•    Requires a current American Academy of Professional Coders (AAPC) CPC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P coding certification
•    Proficiency in Microsoft Word, Excel and SharePoint required.
•    Must possess strong research skills and perform well independently and in a team setting

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.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.