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Provider Reimbursement Admin

Company: Anthem, Inc
Location: San Jose
Posted on: December 5, 2019

Job Description:

Provider Reimbursement Admin - PS27676Location: United StatesRequisition #: PS27676Post Date: Nov 23, 2019Your Talent. Our Vision. At Anthem, Inc. ,its apowerful combination, and the foundation upon which were creating greater accessto care for our members, greater value for our customers, and greater healthfor our communities. Join us and together we will drive the future of healthcare .Thisis an exceptional opportunity to do innovative work that means more to you andthose we serve atoneof America's leading health benefits companies and a Fortune Top 50 Company.Provider Reimbursement AdminOpen to most Anthem locations; for a remote arrangement we prefer applicants to be within 50 miles of an Anthem officeEnsures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editingpolicies 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 editingrules, as well as conducts clinical research, data analysis, and identification of legislative mandates to support draftdevelopment 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, reimbursementdevelopment, 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 foraccuracy.
  • 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.Requires a BA/BS degree; 2-3 years related experience; or any combination of education and experience, which wouldprovide an equivalent background. RN preferred. Coding Certification required: Certified Professional Coder (CPC),Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or similar/comparable Certification.Anthem, Inc. is ranked as one of AmericasMost Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at An Equal Opportunity Employer/Disability/Veteran.

Keywords: Anthem, Inc, San Jose , Provider Reimbursement Admin, Administration, Clerical , San Jose, California

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