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Anthem, Inc. Provider Reimburse Admin in Tampa, Florida


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 care companies and a Fortune Top 50 Company.

Job Description

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The 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.

  • Reviews medical documentation and code assignment and sequencing in accordance with the various code sets, ICD-10-CM Official Guidelines for Coding and Reporting, and query best practices to determine if the diagnoses and procedures are coded/sequenced correctly in collaboration with a Clinical Team.

  • Coordinates research and responds to system inquiries and appeals.

  • Conducts research of claims systems and system edits to identify coding issues and to audit medical documentation for accuracy.

  • Performs complex audits to ensure proper coding was utilized.

  • Prepares correspondence to providers regarding coding and fee schedule updates.

  • Experience working in a production environment with short timelines is strongly required.

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    Required certifications and education: RHIA, RHIT, CCS, CIC, CDIP certifications and/or RN. BA/BS degree preferred

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    Location: This is a work-from-home opportunity.

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    Primary location: TX- Work from Home

    OheOO Other locations: TX, CA, NY, VA, CO, KY, NV, FL, NC, TN, OH, IL

    Applicable to Colorado Applicants Only

  • Annual Salary Range*: $57,795-72,244

  • Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

    • The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.


Requirements Qualifications

  • BA/BS degree; 2-3 years related experience; or any combination of education and experience, which would provide an equivalent background.

  • Time Management skills is essential.

  • Commercial & GBD business products knowledge/experience a plus.

  • WGS and FACETS experience preferred.

  • Requires a current American Academy of Professional Coders (AAPC) CIC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS certification or RN

  • Proficiency in Microsoft Word, Excel and SharePoint required.

  • Must possess strong research skills and perform well independently and in a team setting.

    We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

    REQNUMBER: PS54153-Florida