Middletown, IN, United States
(Facets/QNXT) Provider Reimburse Admin - (Any Anthem location or remote) - PS18298
Location: United States
Field: Provider Network Management
Requisition #: PS18298
Post Date: 8 hours ago
Your Talent. Our Vision. At Anthem, Inc., itâ€™s a powerful combination, and the foundation upon which weâ€™re
creating greater care for our members, greater value for our customers, and
greater health for our communities. Join us and together we will drive thefuture 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.
The Provider Reimbursement Administrator ensures accurate
adjudication of claims by conducting root cause research of potential pricing
and benefit configuration issues and provider appeals. Research includes, but is not limited to review of core
configuration, provider contracts, business requirements documentation, medical
policies, reimbursement policies, and clinical editing policies. Primary duties may include, but are not limited
Conducting in-depth research into claims inquiries andprovider appeals to determine root cause related to pricing and benefitconfiguration.
Working with internal partners to confirm/validatehistorical configuration design and implementation.
Working with internal departments on workflow developmentand business process improvements.
Utilizing advanced critical thinking and analytical skillsto identify trends in configuration issues across markets and lines ofbusiness.
BA/BS degree; 2 years related experience; or anycombination of education and experience, which would provide an equivalentbackground
Advanced critical thinking / analytical / problem solvingskills required
FACETS or QNXTexperience required
SQL or Access or SAS experience required; the ability toquery and build reports
Experience communicating and presenting data to variousaudience members at all levels required
Experience facilitating meetingspreferred
Demonstrated knowledge and experience in the theseareas is required for the role and must be included in the related or equivalentexperience to meet the basic qualifications listed above.
Please note, this position may be located in any Anthem
site location or remote.
Anthem, Inc. is ranked as one of Americaâ€™s MostAdmired Companies among health insurers by Fortune magazine and is a 2018DiversityInc magazine Top 50 Company for Diversity. To learn more about ourcompany and apply, please visit us at antheminc.com/careers. An EqualOpportunity Employer/Disability/Veteran
Website : http://www.antheminc.com
The company was formed when WellPoint Health Networks Inc. and Anthem, Inc. merged in 2004 to become the nation's leading health benefits company. The parent company originally assumed the WellPoint, Inc. name at the time of the merger. In December 2014, WellPoint, Inc. changed its corporate name to Anthem, Inc. The Anthem brand is built on a foundation of trust â€“ itâ€™s the name consumers are most familiar with as a trusted health care partner through our affiliated health plans. Anthem, Inc. is one of the largest health benefits companies in the United States. Through its affiliated health plans, Anthem companies deliver a number of leading health benefit solutions through a broad portfolio of integrated health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts. Headquartered in Indianapolis, Indiana, Anthem, Inc. is an independent licensee of the Blue Cross and Blue Shield Association serving members in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin; and specialty plan members in other states.