Business Analyst II (PS38002)
Vacancy expired!
Description SHIFT: Day JobSCHEDULE: Full-timeYour 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.Business Analyst II (PS38002)Work Location – Open to any Anthem office, can also work from homeThis 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.Provide expertise in researching, formulating recommendations, and providing guidance on claims overpayment initiatives. Serves as a subject matter expert for the organization. Consults with management on solutions to global business issues and organization improvements. This position has a strong understanding of systems and enterprise wide strategic focus. Provides collaborative input toward direction and guidance of team initiatives and brings business expertise to organizational solutions. Primary duties may include, but are not limited to:
Serves as the liaison for business and IT to translate complex business needs to application software for overpayment identification
Completes all required documents to articulate business requirements for query development
Develop project plans, identify and coordinate resources in and outside of RIA to identify and recover overpayments
Performs data analysis and makes recommendations based on the results
Analyze claim payment data to identify overpayment recovery opportunities
Follow project through project lifecycle (i.e. Business Partner Input, Creation of BRD and subsequent changes, Query build, UAT, Production Approval)
Uses discretion in making independent decisions
Identify opportunities for savings to meet or exceed Cost of Care/ASO Group savings goals
Monitor reporting to ensure CoC and ASO Group savings are optimized
Familiarity with ASO contracts / exclusions
Determine if ITS Host claims meet industry/Anthem best practice reimbursement policies
Required skills:
5+ years of experience with WGS and/or NASCO claims processing experience
1-2 years experience with ITS claims processing (Home or Host)
Understanding of CMS rules & guidelines, reimbursement policies, member contracts and benefits for commercial products
Interpretation of provider contracts for professional providers and facilities
Knowledge of pricing research (NetworX, WGS Pricer, etc.)
Identification of claim overpayment scenarios
Familiarity with Business Requirements Document (BRD) writing
Research and data analysis experience
Excellent verbal and written communication, effective virtual presentation and facilitation skills
Intermediate proficiency in Microsoft Excel
Ability to manipulate large sets of data
Strong analytical, organizational, presentation, collaboration, decision making and problem- solving skills
Project Management experience and/or CPC Certification a plus.Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2019 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 Employer/Disability/Veteran.REQNUMBER: PS38002
Vacancy expired!