/Your Talent. Our Vision./At Anthem, Inc.,it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we willdrive 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.
As a member of the quality pricing configuration team, you will play a part in assuring that the quality of complex and/or highly sensitive health care programs are monitored and evaluated. The candidate in this position will prepare and communicate information to appropriate parties regarding health care programs and their level of quality as well as elevate team member performance providing feedback to management to assist with performance improvement and staff development.
The Provider Reimbursement Manager is responsible for managing key components of the provider reimbursement strategy. Primary duties may include, but are not limited to:
Leads fee schedule development for specific plan(s) and/or the development and implementation of clinical editing rules.
Serves as knowledge and resource expert for assigned functions and projects, ensuring the implementation and execution of the same, monitoring adherence to the prescribed quality methodologies and documentation, and completing analysis and trending of quality results.
Works with the Health Service Area, actuarial, decision support, and underwriting to ensure that accurate cost of care targets are incorporated into product pricing and the company¿s financial plans.
Performs and/or directs complex fee modeling exercises to ensure that projected unit reimbursement changes meet corporate cost targets.
Prepares and presents cost of care data analysis to support the regions cost of care initiatives.
Develops and maintains the provider reimbursement strategy that will lower the cost of care, improve service, and reduce administrative expenses.
Manages special projects and initiatives.
Requires a BA/BS degree in a related field; 7 years reimbursement experience including performing detailed financial modeling and economic analyses; or any combination of education and experience, which would provide an equivalent background.
CPA, MGA MBA or other equivalent advanced degree preferred.
Additional Preferred Qualifications
Running Microsoft Access queries in relation to Facets
Team lead experience
/Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran./
Job Provider Network Management
Equal Employment Opportunity Statement
Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title: Provider Reimburse Manager - Nationwide or Telecommute - 136400
Location: nevada-Las Vegas
Requisition ID: 136400
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