Anthem, Inc. Clinical Qual/Compli Admin in Lexington, Kentucky
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 care companies and a Fortune Top 50 Company.
Work Location: This position will work from either our Tampa, FL or Miami, FL office location. Work At Home is not available.
This position is responsible for coordinating and conducting internal Medicare audits and activities related to Medicare compliance at the health plan.
Primary duties may include, but are not limited to:
Develops and maintains pertinent CMS Medicare compliance plans.
Monitors adherence to plans and prepares status reports.
Conducts audits, identifies training and communication needs, and implements related programs as pertaining to Medicare audit and remediation.
Ensures all policies and procedures are updated as legislation or CMS/Medicare standards change.
Implements standardization of procedures and documentation within operations departments and health plan.
Develops and delivers executive level presentations and represents senior management on compliance issues and related committees.
Requires a BA/BS; 3 years of compliance, audit or quality improvement experience; or any combination of education and experience, which would provide an equivalent background.
Experience with regulatory/accreditation audits and knowledge of regulatory/accreditation standards in a health or managed care environment is preferred.
Ability to travel overnight maybe required.
Strong organizational skills and project management skills.
Experience in Medicare Operations strongly preferred.
Ability to work from our Tampa or Miami, FL office location required.
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.