Anthem Provider Reimbursement Admin - Norfolk, VA - PS4239 in Norfolk, Virginia

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 Provider Reimbursement Adminposition will support pre and post payment review of claims, by requesting, processing and routing incoming medical records and itemized bills.

Primary duties may include, but are not limited to: * Utilizes guidelines and review tools to analyze assigned claims and medical records to route to nursing and/or medical staff for review.
* Conducts data analysis and research to properly label incoming records and identify 1st and 2nd level appeals.
* Serves as a liaison to health plan operations, claims adjudication, provider relations, and other internal departments.
* Coordinates research to respond to provider inquiries and appeals, via phone or email.
* Conducts research of claims systems and internal databases to identify issues related to delayed or incomplete reviews.
* Assists with keeping correspondence materials up to date and compliant.
* Works with provider contracting staff when necessary to identify exceptions to our reimbursement policies and procedures.
* Works with our internal compliance department to report known HIPAA violations.

  • Requires a BA/BS degree; 2-3 years related experience; or any combination of education and experience, which would provide an equivalent background.
  • Proficiency with medical coding and medical terminology required.
  • CPC certification
  • SQL experience a plus Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at 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 Reimbursement Admin - Norfolk, VA - PS4239

Location: VA-Norfolk

Requisition ID: PS4239