Anthem, Inc. Hiring for Provider Reimburse Admin Sr at Anaheim, California Full Time

Description

SHIFT: Day Job

SCHEDULE: Full-time

Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Serves as subject matter expert regarding reimbursement policies, edits, and coding conventions.

Primary duties may include but are not limited to:

Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, 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

Requires a BA/BS degree; 4-6 years related experience; or any combination of education and experience, which would provide an equivalent background.

This position requires you to be a Certified Professional Coder. This position will require you to possess claim platform knowledge, preferably WGS and/or GBD Facets.

REQNUMBER: PS51192