Provider Reimburse Admin

Anthem, Inc in Doral, FL

  • Type: Full Time
position filled
Provider Reimburse Admin **Location:** **United States** **Requisition #:** PS31764 **Post Date:** Dec 18, 2019 _Your Talent. Our Vision._ **At Anthem, Inc.,** it's a powerful combination, and the foundation upon which we'recreating greater access to care for our members, greater value for ourcustomers, and greater health for our communities. Join us and together wewill **drive the future of health care** . This is an exceptional opportunity to do innovative work thatmeans more to you and those we serve at one of America's leading healthbenefits companies and a Fortune Top 50 Company. The **Provider Reimburse Admin** ensures accurateadjudication of claims, by translating provider contracts, reimbursementpolicies, and clinical editing policies into effective and accuratereimbursement criteria. Must be able to successfully perform all theduties of the Provider Reimburse Admin. Primary duties may include, but are not limited to: + Reviews company specific, CMS specific, and competitorspecific reimbursement policies, editing rules, coding guidelines, andprovider contract language, as well as conducts coding research, dataanalysis, and identification of legislative mandates to support draftdevelopment and/or revision of enterprise reimbursement policy. + 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 inquiriesand appeals. + Conducts research of claims systems and system edits toidentify adjudication issues and to audit claims adjudication foraccuracy. + Performs pre-adjudication and post-adjudication claimsreviews to ensure proper coding was used. + Prepares correspondence to providers regarding codingand fee schedule updates. + Trains customer service staff on system issues. + Works with provider contracting staff when new/modifiedreimbursement contracts are needed. Qualifications: + Requires a BA/BS degree; 2-3 years related experience;or any combination of education and experience, which would provide anequivalent background. + Coding Certification required Certified ProfessionalCoder (CPC) or Certified Coding Specialist (CCS) required + Certified Professional Medical Auditor Preferred **_Anthem, Inc. is ranked as one of America'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 careers.antheminc.com. An EqualOpportunity Employer/Disability/Veteran._** </script>

You may be interested in these similar jobs!
Big Data Developer
TekPartners in Coral Gables, FL

Qualifications: Strong expertise in Apache Spark using Scala and PySpark is mandatory Experience in Hive, Sqoop, noSQL databases are required…

Read More
Premium Admin
Levy in Miami, FL

Join our team for the 2019-2020 Miami HEAT NBA Season! Levy Restaurants is proud to be the food & beverage provider for American Airlines Arena! NOW…

Read More
Permanent Physiatry Physician in Florida (Miami)
Recruitwell in Miami, FL

Physiatry physician job in Florida : Jacksonville, Florida, PM&R; Opportunity Clinical Role: Seeking a board certified or truly board eligible physia…

Read More
Informatica Admin
Ikcon Technologies in Miami, FL

IKCON TECHNOLOGIES INC delivers exceptional IT services and solutions that provide clients with definite edge over competitors and promoting highest …

Read More
C01T03L011J471-18848-5195 : Network Administration
VDART in Miami, FL

VDart We are a Global Information Technology Services & Workforce Solutions firm headquartered out of Atlanta, GA with presence in US, Canada, MX, UK…

Read More
Staff Engineer
Twenty First Century Engineering in Miami, FL

Looking for a highly motivated Forensic/Construcion/Structural Engineer to work with experienced team members to perform a variety of inspections for…

Read More
Culinary Admin
Levy in Miami, FL

Join our team for the 2019-2020 Miami HEAT NBA Season! Levy Restaurants is proud to be the food & beverage provider for American Airlines Arena! NOW…

Read More
Specialist - Business Support II
Experis in Hialeah, FL

Specialist - Business Support II Jacksonville, FL Job Description: Specialists apply discipline-specific or institutional knowledge and skills in the…

Read More
Siebel Admin
VolantSoft in Hialeah, FL

Job Title: Siebel Admin Location: FL Visa: Open Passport Number Mandatory 6-8 Years of Siebel development experience and 8.2 and higher versions. Str…

Read More
MS Exchange Engineer / Admin
F2ONSITE in Miami, FL

We have an opening for the following: Our client has an immediate need for a contract MS Exchange Engineer/Admin. Skills set and experience should …

Read More