AppleValleyRecruiter Since 2001
the smart solution for Apple Valley jobs

Provider Reimbursement Admin

Company: Anthem
Location: Apple Valley
Posted on: November 28, 2019

Job Description:

Provider Reimbursement Admin - PS27676Location: United StatesNewRequisition #: PS27676Post Date: About an hour agoYour Talent. Our Vision. At Anthem, Inc. ,its apowerful combination, and the foundation upon which were creating greater accessto care for our members, greater value for our customers, and greater healthfor our communities. Join us and together we will drive the future of healthcare .Thisis an exceptional opportunity to do innovative work that means more to you andthose we serve atoneof America's leading health benefits companies and a Fortune Top 50 Company.Provider Reimbursement AdminOpen to most Anthem locations; for a remote arrangement we prefer applicants to be within 50 miles of an Anthem officeEnsures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editingpolicies 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 editingrules, as well as conducts clinical research, data analysis, and identification of legislative mandates to support draftdevelopment 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, reimbursementdevelopment, 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 foraccuracy.
  • Performs pre-adjudication claims reviews to ensure proper coding was used.
  • Prepares correspondence to providers regarding coding and fee schedule updates.
  • Trains customer service staff on system issues.
  • Works with provider contracting staff when new/modified reimbursement contracts are needed.Requires a BA/BS degree; 2-3 years related experience; or any combination of education and experience, which wouldprovide an equivalent background. RN preferred. Coding Certification required: Certified Professional Coder (CPC),Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA), or similar/comparable Certification.Anthem, Inc. is ranked as one of AmericasMost Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at An Equal Opportunity Employer/Disability/Veteran.

Keywords: Anthem, Apple Valley , Provider Reimbursement Admin, Administration, Clerical , Apple Valley, California

Click here to apply!

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

I'm looking for
in category

Other Administration, Clerical Jobs

Administrative Assistant - Front Desk Receptionist
Description: Moffatt Nichol is actively searching for a Receptionist for our Long Beach Office, which is Moffatt Nichol s headquarters , who will provide outstanding customer service to internal and external (more...)
Company: Moffatt & Nichol
Location: Long Beach
Posted on: 12/12/2019

Administrative Assistant
Description: DescriptionOfficeTeam is looking for an outgoing and efficient Administrative Assistant to support three Managing Directors and one Director. The ideal Administrative Assistant is success driven and is (more...)
Company: Robert Half Office Team
Location: Huntington Beach
Posted on: 12/12/2019

Senior Sales Administrative Assistant
Description: KARL STORZ SE Co. KG based in Tuttlingen, Germany, is a family-owned, global company committed to benefiting humanity by advancing medical technology through innovation and education. br br br (more...)
Company: Karl Storz Endoscopy
Location: El Segundo
Posted on: 12/12/2019

General Office Clerk
Description: DescriptionOfficeTeam is currently seeking an organized and talented General Office Clerk for a CPA firm located in Mission Viejo. It is busy season for this CPA firm and is need of a dedicated temporary (more...)
Company: Robert Half Office Team
Location: Mission Viejo
Posted on: 12/12/2019

Description: DescriptionOur client located in Fountain Valley is seeking a dynamic receptionist to manage the front desk. The receptionist will be the first point of contact for the company, will welcome guests and (more...)
Company: Robert Half Office Team
Location: Fountain Valley
Posted on: 12/12/2019

Scheduling Coordinator - Front Office Clerk
Description: Schedule: Monday - Friday, 0800 - 1730Duration: Six months Extendable Description: Receptionist/ Scheduling, heavy phones, patient scheduling.Education: High School
Company: Quik Travel Staffing
Location: Pomona
Posted on: 12/12/2019

Description: DescriptionOfficeTeam has a client located in Costa Mesa who is seeking an articulate receptionist to manage the front desk who will be the first point of contact for the company. The receptionist welcomes (more...)
Company: Robert Half Office Team
Location: Costa Mesa
Posted on: 12/12/2019

Receptionist/Administrative Assistant
Description: We are adding to our team in beautiful Newport Beach The Sares Regis Group of Newport Beach, California, is a privately held real estate development, investment and management firm that focuses on commercial (more...)
Location: Newport Beach
Posted on: 12/12/2019

Front Office Admin Support - Audiology Clinic
Description: Responsibilities br br In the CareConnect and CICAREnenvironment, candidate is responsible for the br following activities: br br -Check-innpatients as they arrive for their appointments - this (more...)
Company: University of California - Los Angeles Medical Cen
Location: Los Angeles
Posted on: 12/12/2019

Description: SunIRef:Manu:title SECRETARY OFFICE AUTOMATION US Department of Defense 5,024 reviews - El Segundo, CA 43,012 - 55,921 a year US Department of Defense 5,024 reviews Read what people are saying about (more...)
Company: US Department of Defense
Location: El Segundo
Posted on: 12/12/2019

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Apple Valley RSS job feeds