Anthem, Inc. Provider Reimburse Admin in North Miami Beach, Florida
SHIFT: Day Job
Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination. It’s 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.
CareMore is a proven care delivery model for the highest-risk. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. We build and lead integrated, multi-disciplinary clinical teams to care for the most complex patients. We strive for excellence and have achieved significant and measurable improvement in total cost of care, clinical outcomes, and experience. As an Anthem subsidiary, we benefit from the scale and resources one of America’s largest managed healthcare organizations.
Remote/Telecommute position- $1,000 Sign-On Bonus
The Provider Reimburse Admin 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. •Prepares correspondence to providers regarding coding and fee schedule updates. •Trains customer service staff on system issues. Works with provider contracting staff when new/modified reimbursement contracts are needed.
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. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s 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.
•Requires a BA/BS degree in Health Care Management, Accounting or Business and a minimum of 23 years’ related experience; or any combination of education and experience, which would provide an equivalent background. •CPC certification required. •At least 23 years’ coding experience strongly preferred. •Experience in health insurance reimbursement, medical billing, medical coding, auditing, or health data analytics preferred. •Requires strong oral and written communication skills, excellent analytical and problem solving skills, strong decision making skills, ability to manage multiple tasks in a demanding work environment, appreciation of cultural diversity and sensitivity towards target membership population, high energy level, self-motivating and able to handle several projects at a time. •Proficiency with MS Outlook, Word and Excel required.
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.