BatonRougeRecruiter Since 2001
the smart solution for Baton Rouge jobs

Provider Reimburse Admin/Admin Sr

Company: Anthem, Inc
Location: Baton Rouge
Posted on: January 17, 2020

Job Description:

Provider Reimburse Admin/Admin Sr (PS32078)Location: Virginia, United StatesRequisition #: PS32078Post 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 is open to any Anthem facility, and also may consider a remote arrangement (VA, IN, GA, or NY preferred).Provider Reimbursement Admin Sr:Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies 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 and edits 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.Provider Reimbursement Admin: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.This position is posted as a job family and the selected candidate will be placed into the level commensurate with their education and experienceProvider Reimbursement Admin Sr:Requires a BA/BS degree; 4+ years Facets NetworX pricing configuration experience; or any combination of education and 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 if required to clarify intentThe 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 manager/winstrat (if exists in market)Provider Reimbursement Admin:Requires a BA/BS degree; 2+ years of Facets experience; or any combination of education and experience, which would provide an equivalent background. Facets NetworX experience preferred.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, Baton Rouge , Provider Reimburse Admin/Admin Sr, Administration, Clerical , Baton Rouge, Louisiana

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


Data Entry Internship - Spring Semester
Description: Background NOEEN is a new nonprofit entity that helps manage network of over 150 child care centers, schools, Head Start programs and non-profit organizations, all working together to ensure that every (more...)
Company: agenda for children
Location: New Orleans
Posted on: 01/30/2020

Administrative Specialist
Description: Title:--Administrative Specialist, trepwiseCompany Overview: trepwise is a growth consulting firm that powers organizations to maximize their potential. Named by New Orleans City Business as the best (more...)
Company: trepwise
Location: New Orleans
Posted on: 01/29/2020

Administrative Officer
Description: SummaryAlexandria VA Health Care System AVAHCS Primary Care is dedicated to providing healthcare in an environment that is patient-centric, and promotes excellence in quality and patient safety. The (more...)
Company: Veterans Affairs, Veterans Health Administration
Location: Alexandria
Posted on: 01/29/2020


Receptionist
Description: Receptionist ---Job DescriptionProvides high level customer service in a large corporate environment for a global professional services firm client. Essential Job Functions and Responsibilities: Greet (more...)
Company: C&W Services
Location: New Orleans
Posted on: 01/27/2020

Administrative Assistant Sales - Sheraton New Orleans Hotel - (19160018)
Description: Here's To Your Journey with Sheraton At Sheraton, we go above and beyond in everything we do. We are inspired by our guests and one another and are driven to make things better. We love what we do, and (more...)
Company: Marriott International
Location: Kenner
Posted on: 01/30/2020

Office Assistant
Description: The CSI Companies is actively seeking an Office Assistant -for a contract role with our client in Baton Rouge, LA. This a great chance to join an organization that was recently awarded one of Fortune (more...)
Company: The CSI Companies
Location: Baton Rouge
Posted on: 01/29/2020

Front Office Supervisor - The Moxy
Description: Monitors daily status of rooms, rates, discount rates and packages Maintains current list of available rooms for walk situations
Company: Moxy NOLDA
Location: New Orleans
Posted on: 01/29/2020

Display Coordinator/Office Assistant
Description: Display Coordinator/Office Assistant Date: Jan 21, 2020 Location: Baton Rouge, LA, USA Company: Haverty Furniture Companies, Inc Job Description MAJOR FUNCTION To assist the Display Coordinator, or store (more...)
Company: Havertys
Location: Baton Rouge
Posted on: 01/26/2020

Data Entry Clerk
Description: DescriptionData Entry SpecialistData Entry Specialist Data Entry Clerk OpportunityWe currently have an excellent opportunity for a highly-skilled and motivated Data Entry Specialist in the largest growing (more...)
Company: Robert Half Office Team
Location: Baton Rouge
Posted on: 01/27/2020

Administrative Support Specialist
Description: SummaryThis position is being announced under FEMA's Cadre of On-call Response/Recovery Employee CORE Program. Thisis a temporary appointment in the Excepted Service, not to exceed 2 years, with the (more...)
Company: Federal Emergency Management Agency
Location: Baton Rouge
Posted on: 01/29/2020

Log In or Create An Account

Get the latest Louisiana jobs by following @recnetLA on Twitter!

Baton Rouge RSS job feeds