FortWayneRecruiter Since 2001
the smart solution for Fort Wayne jobs

Provider Reimbursement Admin Sr

Company: Anthem, Inc
Location: Fort Wayne
Posted on: January 16, 2020

Job Description:

Provider Reimbursement Admin SrLocation: Indianapolis, Indiana, United StatesRequisition #: PS32080Post Date: Dec 31, 2019Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were 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 position may reside in Indianapolis, Georgia, Florida, Colorado, New Mexico, Minnesota or Virginia.The Provider Reimbursement Admin Sr. ensures accurate adjudication of claims by translating provider contracts, reimbursement policies, CMS guidelines, and medical policies into effective and accurate reimbursement configuration in FACETS NetworX.Primary duties may include, but are not limited to:

  • Reviewing provider contracts together with Anthem and CMS guidelines to ensure compliant and accurate configuration of critical information systems.
  • Analyzing each new provider contract for coverage, policy, reimbursement development, and implications for system edits.
  • Configuring FACETS NetworX with provider reimbursement terms, PCAs, fee schedules, and code sets.
  • Responding to system inquiries and appeals-- primarily in order to troubleshoot claims adjudication issues related to configuration.
  • Conducting research of claims systems and system edits to identify issues and to audit claims adjudication for accuracy.
  • Creating test claims and performing reviews of claims to ensure proper configuration was used.
  • Working with other departments to resolve system issues.
  • Working with provider contracting staff when new/modified reimbursement contracts are needed.
  • Assisting with the analysis, documentation, configuration, and testing of current and future markets business requirements.
  • Supporting the upgrade of test environments.
  • Serves as a subject matter expert regarding FACETS NetworX codingconventions, reimbursement policies, provider contract language, claims testing, system edits, and FACETS backend tables.
  • Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring policies andedits do not conflict with Federal and state mandates.
  • Works with other departments on claims adjudication workflow development and business process improvements.
  • May lead the full range of provider reimbursement activities for a state(s).
  • Leads projects related to provider reimbursement initiatives.
  • Creates queries and performs updates to backend tables using SQL and/or ACCESS.
  • Serves as a mentor to less experienced administrators.BA/BS degree; 4+ years related experience; or any combination of education and experience, which would provide an equivalent background.Must have demonstrated knowledge and experience in the areas which is required for the role.
    • FACETS pricing configuration or benefit build experience
    • FACETS NetworX experience
    • Able to run Microsoft Access queries in relation to Facets
    • Previous experience in care payer operations to include claims processing, claims auditing, claims testing and/ or claims research
    • Must know how to read and analyze a contract (physician, ancillary and hospital)
    • Able to implement PCAs and load fee schedules
    • Able to use full range of Microsoft Office products proficiently Preferred skills and experience:
    • Medicare or Medicare/Medicaid experience
    • Direct experience in healthcare provider configuration and/or provider data management utilizing FACETS
    • Knowledge of CPT/HCPCS coding
    • Certified coder
    • Experience working with the implementation of new business in a health insurance industry setting
    • Possess the ability to perform backend table updates using Microsoft Access or SQL.Anthem, Inc. is ranked as one of Americas 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.

Keywords: Anthem, Inc, Fort Wayne , Provider Reimbursement Admin Sr, Administration, Clerical , Fort Wayne, Indiana

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Administration, Clerical Jobs


Assistant Administrative -Terminals
Description: Location Name: Indianapolis, INJob/Requisition ID: id Location Address: 1304 Olin Avenue, Indianapolis, IN, United States US , 46222Education Level: High School Diploma/ GED RequiredRelevant Experience (more...)
Company: Marathon Petroleum Corporation
Location: Fort Wayne
Posted on: 01/19/2020

Administrative Assistant
Description: OverviewSeeking an Administrative Assistant --Downtown location - parking provided 15.60 per hour----ResponsibilitiesProvide strategic support to the Fire Prevention and Building Safety Commission, the (more...)
Company: Knowledge Services
Location: Fort Wayne
Posted on: 01/19/2020

Administrative Professional (5562)
Description: Administrative ProfessionalWork Location: Toledo, OHInGenesis is currently seeking an Administrative Professional IV to perform clerical and secretarial tasks. In this role, you will perform tasks such (more...)
Company: InGenesis
Location: Toledo
Posted on: 01/19/2020


Receptionist.
Description: HourlyPosition Purpose: Receives callers at establishment, determines nature of business, and directs callers to destination. ul li
Company: Centene Corporation
Location: Fort Wayne
Posted on: 01/20/2020

Administrative Specialist
Description: Job Description:Performs primary responsibility of delivering administrative assistance for VP, Directors, Managers and Team members including handling incoming calls, communications and subsequent requests, (more...)
Company: Lowe's
Location: Fort Wayne
Posted on: 01/19/2020

Media Internet Customer Service Sales Representative (Home-based)
Description: We are looking for people nationwide interested in working from home that are dependable and looking to make 1,500- 3,000 weekly. You work on your own schedule right from your computer.
Company: Home Job Staffing
Location: Toledo
Posted on: 01/19/2020

Receptionist
Description: 338671BRTitle:ReceptionistWhat you'll do... :Do people think of you as friendly Are you able to work in a fast-paced environment .H R Block is seeking customer-centric seasonal Receptionists who can (more...)
Company: H&R Block
Location: Toledo
Posted on: 01/19/2020

Provider Reimburse Admin/Admin
Description: Provider Reimburse Admin/Admin Sr-PS32117Location: Virginia, United StatesNewRequisition : PS32117Post Date: 6 hours agoYour Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation (more...)
Company: Anthem, Inc
Location: Fort Wayne
Posted on: 01/19/2020

Secretary
Description: SecretaryPrintApplySecretarySalary 28,800.00 AnnuallyLocationCity County Building, INJob TypeFull TimeDepartmentDepartment of Public Safety-IMPDJob Number05332Closing1/23/2020
Company: Indy Gov
Location: Fort Wayne
Posted on: 01/20/2020

Part-Time Receptionist (Entry Level)
Description: Part-Time Receptionist Entry Level ul li Part Time li Indianapolis, IN li Posted 2 days ago li Applications have closedThrivas Staffing Agency Local restaurant is currently
Company: THRIVAS
Location: Fort Wayne
Posted on: 01/20/2020

Log In or Create An Account

Get the latest Indiana jobs by following @recnetIN on Twitter!

Fort Wayne RSS job feeds