Description
SHIFT: Day Job
SCHEDULE: Full-time
Provider Reimbursement Manager
Manages key components of the provider reimbursement strategy.
Work from home anywhere in U.S. (Prefer: IN, GA, VA, PA, WA, TX, FL)
Primary duties may include, but are not limited to:
Leads fee schedule development for specific plan(s) and/or the development and implementation of clinical editing rules.
Works with the Health Service Area, actuarial, decision support, and underwriting to ensure that accurate cost of care targets are incorporated into product pricing and the company’s financial plans.
Performs and/or directs complex fee modeling exercises to ensure that projected unit reimbursement changes meet corporate cost targets.
Provides analytical support for hospital and physician negotiations.
Prepares and presents cost of care data analysis to support the regions cost of care initiatives.
Develops and maintains the provider reimbursement strategy that will lower the cost of care, improve service, and reduce administrative expenses.
Provides technical support and operational direction to junior analysts while supporting the leadership team on key performance goals and reaction to emerging issues.
Qualifications
Requires:
BA/BS degree in a related field;
7+ years reimbursement experience including performing detailed financial modeling and economic analyses; or any combination of education and experience, which would provide an equivalent background.
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.
REQNUMBER: PS57352-Virginia
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