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Anthem Provider Reimbursement Admin Sr. - PS25906 in Des Moines, Iowa

Provider Reimbursement Admin Sr. - PS25906

Location: United States


Requisition #: PS25906

Post Date: 2 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 atone of America's leading health benefits companies and a Fortune Top 50 Company.

Provider Reimbursement Admin Sr.

Open to most locations, may consider a remote arrangement

Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editingpolicies 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 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.

  • Serves as a mentor to less experienced associates.

Requires a BA/BS degree; 4+ years Facets NetworX pricing configuration experience; or any combination of educationand experience, which would provide an equivalent background.

The following are skills and experience that are a must have for this position.

  • Attend meetings and speak on Facets NetworX pricing configuration or alternatives

  • Train team on Facets NetworX pricing configuration and processes

  • Research complex Facets NetworX pricing configuration and inquiries

  • Develop Facets NetworX pricing designs for new pricing methodologies

  • Approve/disapprove contracts in Emptoris (pre-executed contracts), type up Contract Configuration Analysis form ifrequired to clarify intent

The following are preferences for this position

  • Know how to run complex Access queries

  • Backend updates to Facets via Access

  • Ability to migrate configuration from test accounts to other test accounts and then to production

  • Know rate manger/winstrat (if exists in market)

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 An Equal Opportunity Employer/Disability/Veteran.