Provider Payment Appeal Analyst I, II, Sr
DescriptionSHIFT: Day Job
Provider Payment Appeals Analyst I, II, Sr - job family
This position can be filled at Provider Payment Appeal Analyst I, II, or Sr level. The hiring manager will determine the level, based on the candidate’s experience and background.
This position is a 100% remote work from home opportunity open to US based candidate nationwide.
Be part of an extraordinary team
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Build the Possibilities. Make an extraordinary impact.
How you will make an impact:
As a Provider Payment Appeals Analyst you will support the Payment Dispute process across all lines of business and is specifically responsible for the resolution of Provider Payment Appeal requests.
Primary duties include, but are not limited to:
- Reviews and analyzes provider requests to investigate the outcome of a Reconsideration.
- Considers all information when determining whether to uphold or overturn primary decision.
- Works with various departments including Provider Solutions and Health Plan Operations leadership when necessary, to determine root cause and appropriate resolution.
- Must work with Claims Operations to remediate impacted claims.
The Analyst II will also be responsible to manage Claim Payment Appeal escalations and may serve as a liaison between grievances & appeals and /or medical management, legal, service operations and/or other internal departments as appropriate.
The Sr will also serve as the subject matter expert on Claim Payment Appeal projects and internal audits, and be responsible for inventory management, workflow support, monitoring , maintaining and interpreting records on service levels, quality and productivity; develop training tools and train associates.
Provider Payment Appeals Analyst I:
Requires a HS diploma or GED and a minimum of 3 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry; or any combination of education and experience which would provide an equivalent background.
Provider Payment Appeals Analyst II:
Requires a HS diploma or GED and a minimum of 4 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry; or any combination of education and experience which would provide an equivalent background.
Provider Payment Appeals Analyst Sr:
Requires a HS diploma or GED and a minimum of 5 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
- Bachelor's degree preferred.
- Experience with multiple lines of business a plus.
- For the Sr, leadership experience 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.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. 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.
Applicable to Colorado Applicants Only
Hourly Pay Range*: Level I: $21.81/hr - 27.26/hr; Level II: $24.12- 30.14; Sr: $25.92- 32.40.
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
* The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.
Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.
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.