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Provider Reimburse Admin/ Admin Sr

JobFamily: Provider Network Management
Req #: PS62748
Date Posted: Jan 27, 2022

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SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon whichwe’re creating greater access to care for our members, greater value for our customers, and greaterhealth 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 serveat one of America's leading health care companies and a Fortune Top 50 Company.

Job Descriptions:

Primary duties may include, but are not limited to: 

  • Reviews Anthem specific, CMS specific, and competitor specific medical policies, reimbursement policies, coding guidelines and editing rules, as well as conducts research, data analysis, and provider identification in the development of provider education opportunities.
  • Analyzes and monitors claims data.
  • May research and respond to provider inquiries.
  • Perform pre/post payment reviews on providers who continue aberrant billing practices.
  • Interfaces with local Health Plan representatives regarding provider education initiatives.
  • Prepares correspondence to providers regarding correct coding practices.
  • Conducts internal coding reviews as required.
  • Prepares and presents reports defining observations and recommendations.
  • Interfaces with Corporate Special Investigation Unit on identification and referral of potential fraud.
  • Performs other duties as assigned.


Job 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 If you are not vaccinated, your offer will be rescinded unless you provide and Anthem approves a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably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

Provider Reimburse Admin

  • 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. RN strongly preferred.
  • CPC certification required.
  • Experience in health insurance reimbursement, medical billing, medical coding, auditing, or health data analytics preferred.
  • Proficiency with MS Outlook, Word and Excel required.

Provider Reimburse Admin Sr. 

  • Requires a BA/BS degree and a minimum of 4 years related experience; or any combination of education and experience, which would provide an equivalent background. RN; Medical billing and coding certification strongly preferred.
  • CPC certification required.
  • Requires experience in analysis in health care utilization, clinical or managed care environment.
  • Previous experience auditing professional and/or facility coding preferred.
  • Proficiency with MS Outlook, Word and Excel required.
  • Experience with MS Access preferred.

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 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.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.