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Anthem, Inc. Claims Overpayment Analyst ll in Las Vegas, Nevada

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 benefits companies and a Fortune Top 50 Company.

The Cost Containment Unit (CCU) is an operational unit that leads the effort to identify, analyze, validate and avoid medical overpayments. Cost Containment’s goal is to deliver measurable cost savings through expense recovery and cost avoidance.

The Business Analyst II

Work Location – Open to any Anthem office/Work from home eligible

Primary duties may include, but are not limited to:

  • Perform data mining utilizing CPT, HCPCS, DRG, ICD-9, ICD-10, etc., to identify recovery opportunities.

  • Research all resource documents and web-sites.

  • Document findings that support the concept.

  • Request and/or run queries as needed to retrieve data.

  • Meet with various business partners as needed.

  • Validate overpayments, complete Approach document and forward necessary files and documents for CCU Load.

  • Submit enhancement request for database updates.

  • Ensures proper review of the Forager Pipeline and Analyst reports.

  • Is able to commit to deliverables and maintain timely turnaround times.

Qualifications

Requires a BS/BA degree, 3-5 years related business analysis or finance experience, or any combination of education and experience, which would provide an equivalent background. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Preferred Requirements:

  • Healthcare business analysis experience

  • Experience in using Excel, Facets and MACESS

  • Medical billing and/or claims processing experience is preferred

  • 2+ years of experience with data analysis, claims processing, provider billing, FWA investigations, cost containment, Medicare, Medicaid, MMP and/or MedSupp plans

  • Medical coding experience - CPT, HCPCS, ICD-9/10 coding

  • CPC or applicable professional designation a plus

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.

REQNUMBER: PS43036

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