RoanokeRecruiter Since 2001
the smart solution for Roanoke jobs

Provider Reimbursement Admin Sr

Company: Anthem, Inc
Location: Roanoke
Posted on: January 17, 2020

Job Description:

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 configuration.
  • 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 tables.
  • 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 initiatives.
  • 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 research
    • 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 An Equal Opportunity Employer/Disability/Veteran.

Keywords: Anthem, Inc, Roanoke , Provider Reimbursement Admin Sr, Administration, Clerical , Roanoke, Virginia

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Administration, Clerical Jobs

Autosys Admin
Description: Net2Source is a Global Workforce Solutions Company headquartered at NJ, USA with its branch offices in Asia Pacific Region. We are one of the fastest growing IT Consulting company across the USA and we (more...)
Company: Net2Source Inc.
Location: Greensboro
Posted on: 01/30/2020

Provider Reimbursement Admin Sr
Description: Provider Reimbursement Admin SrLocation: Indianapolis, Indiana, United StatesNewRequisition : PS32080Post Date: 6 days agoYour Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the (more...)
Company: Anthem, Inc
Location: Roanoke
Posted on: 01/29/2020

Admin Assistant - Corporate Procurement
Description: Headquartered in Lynchburg, Va., BWX Technologies, Inc. NYSE:BWXT is a leading supplier of nuclear components and fuel to the U.S. government provides technical and management services to support the (more...)
Company: BWX Technologies, Inc.
Location: Lynchburg
Posted on: 01/29/2020

Provider Reimbursement Admin Sr
Description: Provider Reimbursement Admin SrLocation: Indianapolis, Indiana, United StatesRequisition : PS32080Post Date: Jan 17, 2020Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the (more...)
Company: Anthem, Inc
Location: Roanoke
Posted on: 01/29/2020

Office Assistant
Description: DescriptionAre you someone who can handle multiple projects at once with a positive outlook Are you a highly skilled Office Assistant with experience performing various administrative duties A thriving (more...)
Company: Robert Half Office Team
Location: Greensboro
Posted on: 01/29/2020

Part Time Data Entry
Description: We are actively seeking work from home customer service and appointment setting representatives. Your
Company: Morani Enterprise
Location: Roanoke
Posted on: 01/29/2020

Administrative Assistant
Description: The ideal candidate will exhibit high standards, excellent communication skills, and have an ability
Company: EEA Companies
Location: Greensboro
Posted on: 01/30/2020

Part- Time Receptionist- Roanoke,VA
Description: Seeking an individual with excellent communication skills to answer phones and greet customers.Other duties are: ul li Balance
Company: Berglund Automotive
Location: Roanoke
Posted on: 01/29/2020

Administrative Assistant
Description: Medical Facilities of America, Inc. is a leading healthcare and rehabilitation company seeking to hire a full time Administrative Assistant who will provide comprehensive administrative support to the (more...)
Company: Medical Facilities of America
Location: Roanoke
Posted on: 01/30/2020

Administrative Project Management Consultant - Fortify Children's Health
Description: The Administrative Project Management Consultant will facilitate successful planning design build implementation and evaluation of departmental activities related to strategic and operational initiatives. (more...)
Company: University of Virginia
Location: Charlottesville
Posted on: 01/29/2020

Log In or Create An Account

Get the latest Virginia jobs by following @recnetVA on Twitter!

Roanoke RSS job feeds