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Anthem, Inc. DRG Coding Provider Reimburse Admin in Pembroke Pines, Florida


SHIFT: Day Job

SCHEDULE: Full-time

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.

This position will allow remote within the US

The Provider Reimburse Admin ensures accurate adjudication of claims, by translating provider contracts, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Must be able to successfully perform all the duties of the Provider Reimburse Admin.

Primary duties may include, but are not limited to:

  • Reviews company specific, CMS specific, and competitor specific reimbursement policies, editing rules, coding guidelines, and provider contract language, as well as conducts coding research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.

  • 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 and post-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.


Requires a BA/BS degree

2-3 years related experience

Or any combination of education and experience, which would provide an equivalent background

Coding Certification required Certified Professional Coder (CPC) required

Additional Certified Coding Specialist (CCS), (CIC), (RHIA/RHIT) preferred

Certified Professional Medical Auditor Preferred

Inpatient DRG coding required

Govt/Commercial experience required

Hospital coding 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 An Equal Opportunity Employer/Disability/Veteran.