Anthem Provider Reimburse Admin Sr – Root Cause Research - Nationwide (Remote Work Available) - PS6315 in Smithfield, Virginia
Provider Reimburse Admin Sr – Root Cause Research - Nationwide (Remote Work Available) - PS6315
Location: United States
Field: Provider Network Management
Requisition #: PS6315
Post Date: 2 days ago
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 atone of America's leading health benefits companies and a Fortune Top 50 Company.
The Provider Reimbursement Administrator Sr. (open to remote work) ensures accurate adjudication of claims by conducting root cause research of potential pricing and benefit configuration issues and provider appeals. Research includes, but is not limited to review of core configuration, provider contracts, business requirements documentation, medical policies, reimbursement policies, and clinical editing policies.
Primary duties may include, but are not limited to:
Conducting in-depth research into claims inquiries and provider appeals to determine root cause related to pricing and benefit configuration.
Working with internal partners to confirm/validate historical configuration design and implementation.
Working with internal departments on workflow development and business process improvements.
Utilizing advanced critical thinking and analytical skills to identify trends in configuration issues across markets and lines of business.
BA/BS degree; 4-6 years related experience; or any combination of education and experience, which would provide an equivalent background
Advanced critical thinking / analytical skills required
FACETS experience required
SQL or Access experience required; the ability to query and build reports
Experience communicating and presenting data to various audience members at all levels required
Experience facilitating meetings preferred
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.