Anthem Provider Auditor or Provider Auditor Sr. - Remote (PS1577) in Norfolk, Virginia

/Your Talent. Our Vision./At Anthem, Inc.,it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we willdrive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve atone of America's leading health benefits companies and a Fortune Top 50 Company.

TheProvider Auditor or Provider Auditor Sr.conducts on-site reviews of medical charts, medical notes, itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards.

Primary duties may include, but are not limited to: * Selects providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. * Schedules review with provider, analyzes data to select claims to be reviewed, conducts review using medical charts, medical notes, itemized bills and provider contracts. * Conducts exit interview with provider management team by presenting preliminary review results. * Verifies dollar amount on claim is correct in claims system and writes report of the findings of the review and requests payments for any overpayments. * Identifies aberrant patterns of billing and detects potential abuse. * Mentors and trains Provider Auditor as needed. * Drafts department policies and procedures and other educational materials. * Works on task forces and committees representing functional area. Requires either a BA/BS degree or Registered Nurse; certification in a clinical practice or medical coding or provider reimbursement auditing or 5 years equivalent work experience; or any combination of education and experience, which would provide an equivalent background. RN or medical coding certification preferred. Must be able to travel at least 25%. EOE.M/F/Disability/Veteran

_Provider Auditor_ * Requires either a BA/BS degree or Registered Nurse; certification in a clinical practice or medical coding or provider reimbursement auditing or 2-4 years equivalent work experience; or any combination of education and experience, which would provide an equivalent background. * RN or medical coding certification preferred. * Must be able to travel at least 25%.

_Provider Auditor Sr. _ * Requires either a BA/BS degree or Registered Nurse; certification in a clinical practice or medical coding or provider reimbursement auditing or 5 years equivalent work experience; or any combination of education and experience, which would provide an equivalent background. * RN or medical coding certification preferred. * Must be able to travel at least 25%.

/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.__/

Job Provider Network Management

Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.

Title: Provider Auditor or Provider Auditor Sr. - Remote (PS1577)

Location: virginia-Norfolk

Requisition ID: PS1577