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Anthem, Inc. Reimbursement Dispute Analyst - Licensed position in Newbury Park, California

Description

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.

Reimbursement Dispute Analyst - licensed position

Remote within one hour commuting distance to any CA Anthem office-you must reside and be licensed in the state of CA

Responsible for reviewing the most complex provider appeals that have already been reviewed.

Primary duties may include:

  • Examines claims for compliance with relevant billing and processing guidelines.

  • Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations.

  • Researches, validates and stays abreast of new healthcare related questions, medical coding and billing issues, trends and changes in regulations and industry standards to recommend policy and procedure review or modifications.

  • Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.

  • May overturn prior decisions.

  • Communicates decision to the provider based on the outcome of the investigation.

  • Monitors and manages appeals inventory.

  • Trains new associates.

  • Develops, designs and implements new or revised methods to improve the operations.

Qualifications

Requires:

  • AAS (LPN or LVN,) RN preferred

  • 4+ years related medical coding and/or auditing experience

  • 3 years of handling provider disputes complaint/dispute and written correspondence

  • or the equivalent combination of education and experience.

  • Must have knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology

  • Coding certification preferred or must be obtained within 6 months from date of hire (CPC, CCS, CPMA, AAPC, AHIMA)

  • BA/BS preferred

  • WGS claims research and edit logic experience preferred

  • Pega NextGen experience preferred

  • Microsoft Word and Excel experience preferred.

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: PS38314

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