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Anthem, Inc. Coding Reimbursement Administrator Sr in Reno, Nevada


SHIFT: Day Job

SCHEDULE: Full-time

Your 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.

This is an office-based position, in our Norfolk, VA facility. Relocation is not available for this opportunity.

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.

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.