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Anthem, Inc. Coding Provider Reimburse Admin or Admin Sr (job family) in Las Vegas, Nevada

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem Blue Cross and Blue Shield, a proud member of the Anthem, Inc. family of companies, 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.

Position will be filled at the level of experience of candidate selected.

Eligible to work from Anthem offices in Nevada (preferred), will consider California, or work from home in either state only

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.

  • Ensures deadlines are met.

  • Ensures productivity requirements are met along with ensuring the quality of work.

The Coding (Provider) Reimbursement Administrator Sr. 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 code edits and coding conventions.

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.

  • Ensures productivity requirements are met along with ensuring the quality of work.

  • Serves as subject matter expert claims and edits.

Qualifications

Coding (Provider) Reimbursement Administrator:

  • Requires a BA/BS degree

  • RN/LPN preferred

  • 2-3 years related experience; or any combination of education and experience, which would provide an equivalent background

  • Medicaid Commercial business products knowledge/experience a plus

  • WGS and FACETS experience preferred.

  • Requires a current American Academy of Professional Coders (AAPC) CPC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P coding certification

  • Proficiency in Microsoft Word, Excel and SharePoint preferred

  • Must perform well independently and in a team setting

Coding (Provider) Reimbursement Administrator Sr:

  • Requires a BA/BS degree

  • RN/LPN preferred

  • 4-6 years related experience; or any combination of education and experience, which would provide an equivalent background.

  • Medicaid Commercial business products knowledge/experience a plus.

  • WGS and FACETS experience preferred.

  • Billing experience preferred.

  • Requires a current American Academy of Professional Coders (AAPC) CPC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P coding certification

  • Proficiency in Microsoft Word, Excel and SharePoint required.

  • Must possess strong research skills and perform well independently and in a team setting

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

REQNUMBER: PS40113

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