Anthem, Inc. Business Information Consultant in Norfolk, Virginia
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.
Responsible for serving as an expert in data analysis, reporting and formulating recommendations and providing guidance to other data analysts.
Location - Norfolk, VA Office
Primary duties may include, but are not limited to:
Provides consultation on data sets based on the HIPAA transactions and code set standards, 837I, 837P, 837D, NCPDP, ACK, 277, and 835. Also consults on pharmacy NCPDP, and proprietary file formats.
Minimum of three years experience with Edifecs system producing encounters for submission te external state entitities.
Familiar with state companion guides for 837 and other state technical documentation for submission files and interpretation of response files.
Able to interpret companion guides, technical documents, contacts, and state directives and create detailed requirement specifications for medical encounters reporting to state and other government agencies, develops corresponding test cases to test requirements, and provides analysis for the creation of test data.
Represent Anthem encounter team in meetings with state, project status meetings and health plan demonstrating understanding of topics presented and discussed on behalf of encounters team.
Creates and maintains encounters test data regression test bed.
Creates and maintains databases to track business performance.
Analyzes data and summarizes performance using summary statistical procedures.
Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
Creates and publishes periodic reports, as well as any necessary ad hoc reports.
May require taking business issue and devising best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.
May make recommendations based upon data analysis.
Provides analytic consultation to other business areas, leadership or external customers.
Data analysis and reporting encompasses a much higher level of complexity.
Requires a BS/BA degree in related field; minimum of 5 years experience; or any combination of education and experience, which would provide an equivalent background. Experience with relational databases and knowledge of query tools and statistical software is required. Ability to manipulate large sets of data. Strong analytical, organizational, presentation, and problem solving skills. Expert understanding of HIPAA transactions and code set standards, 10 years of health care experience with clean claims processing and upstream inputs; provider, member, and benefits configuration. Effectively communicate in written form and orally with internal Anthem teams, external state customers, external vendors, and leadership providing reports on status, issues, risks, and mitigations.This job is more focused on higher level technical expertise, mentoring staff in lower job levels, more customer facing, higher level of collaboration, work is higher volume and/or higher risk, and modeling as compared to the Bus Info Analyst Sr job. 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.