Provider Reimbursement Admin Sr
Company: Anthem, Inc
Posted on: January 17, 2020
Provider Reimbursement Admin SrLocation: Indianapolis, Indiana,
United StatesRequisition #: PS32080Post Date: Dec 31, 2019Your
Talent. Our Vision. At Anthem, Inc., its a powerful combination,
and the foundation upon which were 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 may reside in Indianapolis, Georgia, Florida,
Colorado, New Mexico, Minnesota or Virginia.The Provider
Reimbursement Admin Sr. ensures accurate adjudication of claims by
translating provider contracts, reimbursement policies, CMS
guidelines, and medical policies into effective and accurate
reimbursement configuration in FACETS NetworX.Primary duties may
include, but are not limited to:
- Reviewing provider contracts together with Anthem and CMS
guidelines to ensure compliant and accurate configuration of
critical information systems.
- Analyzing each new provider contract for coverage, policy,
reimbursement development, and implications for system edits.
- Configuring FACETS NetworX with provider reimbursement terms,
PCAs, fee schedules, and code sets.
- Responding to system inquiries and appeals-- primarily in order
to troubleshoot claims adjudication issues related to
- Conducting research of claims systems and system edits to
identify issues and to audit claims adjudication for accuracy.
- Creating test claims and performing reviews of claims to ensure
proper configuration was used.
- Working with other departments to resolve system issues.
- Working with provider contracting staff when new/modified
reimbursement contracts are needed.
- Assisting with the analysis, documentation, configuration, and
testing of current and future markets business requirements.
- Supporting the upgrade of test environments.
- Serves as a subject matter expert regarding FACETS NetworX
codingconventions, reimbursement policies, provider contract
language, claims testing, system edits, and FACETS backend
- Works with vendors and enterprise teams to develop enterprise
reimbursement policies and edits, ensuring policies andedits do not
conflict with Federal and state mandates.
- Works with other departments on claims adjudication workflow
development and business process improvements.
- May lead the full range of provider reimbursement activities
for a state(s).
- Leads projects related to provider reimbursement
- Creates queries and performs updates to backend tables using
SQL and/or ACCESS.
- Serves as a mentor to less experienced administrators.BA/BS
degree; 4+ years related experience; or any combination of
education and experience, which would provide an equivalent
background.Must have demonstrated knowledge and experience in the
areas which is required for the role.
- FACETS pricing configuration or benefit build experience
- FACETS NetworX experience
- Able to run Microsoft Access queries in relation to Facets
- Previous experience in care payer operations to include claims
processing, claims auditing, claims testing and/ or claims
- Must know how to read and analyze a contract (physician,
ancillary and hospital)
- Able to implement PCAs and load fee schedules
- Able to use full range of Microsoft Office products
proficiently Preferred skills and experience:
- Medicare or Medicare/Medicaid experience
- Direct experience in healthcare provider configuration and/or
provider data management utilizing FACETS
- Knowledge of CPT/HCPCS coding
- Certified coder
- Experience working with the implementation of new business in a
health insurance industry setting
- Possess the ability to perform backend table updates using
Microsoft Access or SQL.Anthem, Inc. is ranked as one of Americas
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
careers.antheminc.com. An Equal Opportunity
Keywords: Anthem, Inc, Roanoke , Provider Reimbursement Admin Sr, Administration, Clerical , Roanoke, Virginia
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