Anthem Provider Reimburse Admin - Facets NetworX Configuration - Remote (PS11216) in Hempstead, New York
Provider Reimburse Admin - Facets NetworX Configuration - Remote (PS11216)
Location: United States
Field: Provider Network Management
Requisition #: PS11216
Post Date: 3 days ago
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.
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. Translates medical policies into reimbursement rules. 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 inquiries and appeals. Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy. Performs pre-adjudication claims reviews to ensure proper coding was used. Works with provider contracting staff when new/modified reimbursement contracts are needed.
BA/BS degree; 2-3 years related experience; or any combination of education and experience, which would provide an equivalent background.
Experience implemented Facets NetworX pricing Configuration preferred
Understand applying agreements to providers in Facets preferred
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran .