Coding (Provider) Reimbursement Administrator/ Senior

Company: Anthem, Inc.
Location: Norfolk
Posted on: May 3, 2021

Job Description:

Description

SHIFT: Day Job

SCHEDULE: Full-time

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.

The health and safety of Anthem associates and the various stakeholders we service is a top priority for our business every day. Anthem's workplace of the future will be both physical and virtual with the number of sites optimized to promote access to diverse, top talent.

Coding (Provider) Reimbursement Administrator

The Coding (Provider) Reimbursement Administrator ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.

Primary duties may include, but are not limited to:

* Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducts clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy. Translates medical policies into reimbursement rules. * Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits. * Coordinates research and responds to system inquiries and appeals. * Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. * Performs pre-adjudication claims reviews to ensure proper coding was used. Prepares correspondence to providers regarding coding and fee schedule updates. * Trains customer service staff on system issues. Works with provider contracting staff when new/modified reimbursement contracts are needed.

Coding (Provider) Reimbursement Administrator Senior

The Coding (Provider) Reimbursement Administrator Senior 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

Coding (Provider) Reimbursement Administrator

Requires a BA/BS degree; 2-3 years related experience; or any combination of education and experience, which would provide an equivalent background.

Coding (Provider) Reimbursement Administrator Senior

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

Preferred Qualifications:

* A current American Academy of Professional Coders (AAPC) CPC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P coding certification preferred * Medicaid, Medicare or Commercial business products knowledge/experience a plus. * WGS and/or FACETS experience preferred. * Proficiency in Microsoft Word, Excel and SharePoint 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. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.

Keywords: Anthem, Inc., Norfolk , Coding (Provider) Reimbursement Administrator/ Senior, Other , Norfolk, Virginia