SHIFT: Day Job
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.
Responsible for researching, analyzing, and coordinating the resolution of complex claims issues for the Health Plan, requiring intermediate knowledge of medical coding and claim adjudication guidelines.
Primary duties may include, but are not limited to:
Provide expertise and assistance relative to provider billing and payment guidelines consistent with MO HealthNet (State of MO Medicaid) and Anthem policies and procedures.
Creates and maintains databases to track business performance.
Analyzes data and summarizes performance using summary statistical procedures.
Analyzes provider issues and collaborate with other departments to determine root cause leading to remediation.
Identify and document opportunities for provider education.
Collaborate with the business partners to identify and/or approve concepts for recovery where applicable.
Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
Creates and publishes periodic reports, makes necessary recommendations, and develops ad hoc reports as needed.
May require taking business issue and devising best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.
Requires a BS/BA degree in related field.
Minimum of 2-4 years related operational and/or data analysis experience.Experience in database structures, and standard query and reporting tools; or any combination of education and experience, which would provide an equivalent background.
Qualifications Strongly Preferred:
Intermediate knowledge medical terminology, CPT/HCPCS/UB04 revenue coding, modifiers, and billing regulations, documentation standards, fee schedules, third party billing and documentation standards.
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Knowledge of HIPAA rules and regulations.
Strong proficiency in Microsoft Office, and general computer skills.
This job is more focused on technical expertise and analysis as compared to the Bus Info Analyst I job.
If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a ‘sensitive position’ work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.
Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions.
Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
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.
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