17 Sep
Bus Info Developer Cons Sr
California, Whittier 00000 Whittier 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.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.Bus Info

Developer Cons Sr (PS39179) Location: Must

be within reasonable driving distance of an Anthem office.The Bus Info Developer Cons Sr is a part of the dynamic Anthem Enterprise

Data Science team, and will be focused on convert advanced AI-based insights

into next-generation payment, coding, and clinical edits. He/she ensures

accurate adjudication of claims, by translating medical policies, reimbursement

policies, and clinical editing policies into effective and accurate

reimbursement criteria. Serves as subject matter expert regarding

reimbursement policies, edits, and coding conventions. He/she must

possess good communication and writing skills, and attention to detail is a

must. Primary duties may include, but are not limited to:

Read and analyze payer medical and payment policy, as well as provider

contracts, translating into software edits, to ensure accurate claims payment

Read and

analyze Medicare/Medicaid data and policy, bulletins, manual updates, fee

schedules, translating into software edits, to ensure accurate claims payment

Interpret and

deliver business requirements for required software updates to ensure compliance

with policy, contracting, regulatory changes or updates

Create detailed

testing protocols for ensuring updates to software and edits delivered in

accordance with requirements

Acts as a

source of direction, training and guidance for less experienced staff.

Become

increasingly familiar with Provider Payment systems such as DRG, APC, RBRVS

Requires a BS/BA degree; 5 years experience; or any combination of education

and experience, which would provide an equivalent background.

5 years experience in health care coding, validation of appropriate procedures,

diagnosis and additional codes used in medical billing

At least one of

the following certifications strongly preferred: Certified Professional

Coder (CPC, CPC-P, CPC-H), Certified Coding Specialist (CCS)

Knowledge of

standard payment policy, medical policy, and payer and government regulations

Understanding

of NCCI, MUE, Medicare PFS edits

Knowledge of

medical terminology and anatomy

Ability to

communicate effectively and collaborate with diverse internal and external

stakeholder groups and individuals

Able to

collect, research, and understand diverse information sets, and translate into

clear and concise requirements

FACETS and/or

WGS experience a plus

Anthem, Inc. is

ranked as one of America’s 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 Employer/Disability/Veteran.REQNUMBER: PS39179

Vacancy expired!


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