Reimbursement Dispute Analyst- Licensed

Company: Anthem, Inc.
Location: Glendale
Posted on: May 6, 2021

Job Description:

DescriptionSHIFT: Day JobSCHEDULE: Full-timeYour 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.The health and safety of Anthem associates and the various stakeholders we service is a top priority for our business every day. Anthem's workplace of the future will be both physical and virtual with the number of sites optimized to promote access to diverse, top talent.Preferred Locations: Woodland Hills, CA; Palo Alto, CA; Glendale, CA; Richmond, VA; Indianapolis, IN; Atlanta, GA; Mason, OHResponsible for reviewing the most complex provider appeals that have already been reviewed.Primary duties may include:* Examines claims for compliance with relevant billing and processing guidelines.* Reviews and conducts analysis of claims and medical records prior to payment and uses required systems/tools to accurately document determinations. Researches, validates and stays abreast of new healthcare related questions, medical coding and billing issues, trends and changes in regulations and industry standards to recommend policy and procedure review or modifications.* Collaborates with the Special Investigation Unit and other internal areas on matters of mutual concern.* May overturn prior decisions.* Communicates decision to the provider based on the outcome of the investigation.* Monitors and manages appeals inventory.* Trains new associates.* Develops, designs and implements new or revised methods to improve the operations.QualificationsRequires a AAS (LPN/LVN) or RN (preferred); 4+ years related medical coding and/or auditing experience, 3 years of handling provider disputes complaint/dispute and written correspondence, or the equivalent combination of education and experience.* Must have knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology.* Coding certification preferred or must be obtained within 6 months from date of hire (CPC, CCS, CPMA, AAPC, AHIMA).* Requires a LPN/LVN or RN active unrestricted license in applicable state(s).* BA/BS preferred* WGS claims research and edit logic experience preferred* Pega NextGen experience preferred* Microsoft Word and Excel experience preferred.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. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. 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.

Keywords: Anthem, Inc., Glendale , Reimbursement Dispute Analyst- Licensed, Professions , Glendale, Arizona