14 Aug
Business Analyst II (PS38002)
Kentucky, Lexington 00000 Lexington USA

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!


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