Anthem, Inc. Bus Info Developer Cons Sr in Atlanta, Georgia
SHIFT: Day Job
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.
Bus Info Developer Cons Sr (PS39179)
Location: Must be within reasonable driving distance of an Anthem office.
The Bus Info Developer Cons Sr is a part of the dynamic Anthem Enterprise Data Science team, and will be focused on convert advanced AI-based insights into next-generation payment, coding, and clinical edits. He/she 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. He/she must possess good communication and writing skills, and attention to detail is a must.
Primary duties may include, but are not limited to:
Read and analyze payer medical and payment policy, as well as provider contracts, translating into software edits, to ensure accurate claims payment
Read and analyze Medicare/Medicaid data and policy, bulletins, manual updates, fee schedules, translating into software edits, to ensure accurate claims payment
Interpret and deliver business requirements for required software updates to ensure compliance with policy, contracting, regulatory changes or updates
Create detailed testing protocols for ensuring updates to software and edits delivered in accordance with requirements
Acts as a source of direction, training and guidance for less experienced staff.
Become increasingly familiar with Provider Payment systems such as DRG, APC, RBRVS
Requires a BS/BA degree; 5 years experience; or any combination of education and experience, which would provide an equivalent background.
5 years experience in health care coding, validation of appropriate procedures, diagnosis and additional codes used in medical billing
At least one of the following certifications strongly preferred: Certified Professional Coder (CPC, CPC-P, CPC-H), Certified Coding Specialist (CCS)
Knowledge of standard payment policy, medical policy, and payer and government regulations
Understanding of NCCI, MUE, Medicare PFS edits
Knowledge of medical terminology and anatomy
Ability to communicate effectively and collaborate with diverse internal and external stakeholder groups and individuals
Able to collect, research, and understand diverse information sets, and translate into clear and concise requirements
FACETS and/or WGS experience a plus
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.