Coding Reimbursement Administrator/Senior

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.Position will be filled

at the level of experience of candidate selected.Eligible to work from any Anthem office, or work from home.Coding

(Provider) Reimburse Admin Sr. 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. Primary duties may

include, but are not limited to:

Works with vendors and

enterprise teams to develop enterprise clinical and coding edits, ensuring

policies and edits do not conflict with Federal and state mandates.

Independently interprets

Medical and Reimbursement Policies and Clinical Guidelines.

Completes and maintains

detailed documentation of edit change requests.

Ensures deadlines are met along

with ensuring the quality of work.

Contacts others to obtain any

necessary information.

Identifies claims processing

edit errors and initiates claim adjustment projects.

Serves as a subject matter

expert for claims and edits.

Requires a BA/BS degree; 4-6 years related

experience; or any combination of education and experience, which would provide

an equivalent background. RN or LPN preferred. Medical billing and coding certification

preferred.CPC (Certified Professional Coder) highly preferred. Facets and/or WGS experience preferred.Proficiency with Microsoft Word, Excel and

SharePoint preferred.Must possess strong research skills and perform

well independently and in a team setting.Coding

(Provider) Reimburse Admin ensures accurate adjudication of

claims, by translating medical policies, reimbursement policies, and clinical

editing policies into effective and accurate reimbursement criteria. Primary

duties may include, but are not limited to: · Reviews company specific, CMS specific, and competitor

specific medical policies, reimbursement policies, and editing rules, as well

as conducts clinical research, data analysis, and identification of legislative

mandates to support draft development and/or revision of enterprise

reimbursement policy. · Translates medical policies into reimbursement rules. · Performs CPT/HCPCS code and fee schedule updates, analyzing

each new code for coverage, policy, reimbursement development, and implications

for system edits. · Coordinates research and responds to system inquiries and

appeals. · Conducts research of claims systems and system edits to

identify adjudication issues and to audit claims adjudication for accuracy. · Performs pre-adjudication claims reviews to ensure proper

coding was used. Prepares correspondence to providers regarding coding and fee

schedule updates. · CPC (Certified Professional Coder) highly preferred. · Facets and/or WGS experience preferred.· Proficiency with Microsoft Word, Excel and SharePoint preferred.Requires a BA/BS degree; 2-3 years

related experience; or any combination of education and experience, which would

provide an equivalent background. 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 OpportunityREQNUMBER: PS39552