Provider Reimburse Admin Sr (Configuration Analyst Sr) nationwide #96755
Company Name:
Anthem
We one of the nation's leading health benefits companies and a Fortune Top 50 company. We are working together to transform health care with trusted and caring solutions.
As a member of A Medicare/ Medicaid/ or MMP pricing configuration team, you will play a part in assuring that our Health Plans in your team's assigned market are able to provide the best possible service and care while maintaining our competitive advantage as an innovator in the Medicare.
This position is equivalent to most organizations' Configuration Analyst Sr. role.
/Primary duties may include, but are not limited to:/
Reviewing individual provider contracts together with Anthem, Inc. and CMS guidelines to ensure compliant and accurate configuration of critical information systems.
Analyzing each new provider contract for coverage, policy, reimbursement development, and implications for system edits. (May also perform CPT/HCPCS code and fee schedule updates)
Responding to system inquiries and appeals-- primarily in order to troubleshoot claims adjudication issues related to configuration.
Conducting research of claims systems and system edits to identify issues and to audit claims adjudication for accuracy.
Performing pre-adjudication claims reviews (configuration testing) to ensure proper configuration was used.
Prepares correspondence to providers regarding coding and fee schedule updates.
Trains customer service staff on system issues.
Working with provider contracting staff when new/modified reimbursement contracts are needed.
Assisting with the analysis, documentation, configuration, and testing of current and future markets business requirements.
Supporting the upgrade of test environments
This position does offer flexibility in location for the right associate toWork@Home
Provider Reimbursement Admin Sr
/Requires/:
BA/BS degree
4-6 years related
Previous experience in care payer operations to include claims processing, claims auditing, claims testing and/ or claims research
Knowledge of one or more of the following claims paying systems; FACETS, AMISYS, NASCO, EZ-Cap, Rims, Ocare, Xcelys, NextGen, QNXT, ITS, IKA, WGS, Call Care Browser, GBAS, Genelco, HEALTHsuite, and Diamond
Direct experience in healthcare provider configuration and/or provider data management utilizing FACETS or one of the above listed systems
Must know how to read and analyze a contract (physician, ancillary and hospital)
Able to implement PCAs and load fee schedules
Able to use full range of Microsoft Office products proficiently
Leading or taking a primary role in the configuration of enterprise-class information systems/ software products in a highly regulated business environment
Experience in analysis and design of billing/ collection or similar applications and complex relational databases
or any experience or any combination of education and experience, which would provide an equivalent background.
//
/Preferred:/
Medicaid experience
FACETS specific pricing configuration build experience
FACETS NetworX experience
Able to run Microsoft Access queries in relation to Facets
Knowledge of CPT/HCPCS coding
Certified coder
Experience working with the implementation of new business in a health insurance industry setting
Project management experience
/We are ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at/ / ./ /EOE. M/F/Disability/Veteran./
Job Provider Network Management
Title: Provider Reimburse Admin Sr (Configuration Analyst Sr) nationwide #96755
Location: AZ-Scottsdate
Requisition ID: 96755 Estimated Salary: $20 to $28 per hour based on qualifications.
Anthem
We one of the nation's leading health benefits companies and a Fortune Top 50 company. We are working together to transform health care with trusted and caring solutions.
As a member of A Medicare/ Medicaid/ or MMP pricing configuration team, you will play a part in assuring that our Health Plans in your team's assigned market are able to provide the best possible service and care while maintaining our competitive advantage as an innovator in the Medicare.
This position is equivalent to most organizations' Configuration Analyst Sr. role.
/Primary duties may include, but are not limited to:/
Reviewing individual provider contracts together with Anthem, Inc. and CMS guidelines to ensure compliant and accurate configuration of critical information systems.
Analyzing each new provider contract for coverage, policy, reimbursement development, and implications for system edits. (May also perform CPT/HCPCS code and fee schedule updates)
Responding to system inquiries and appeals-- primarily in order to troubleshoot claims adjudication issues related to configuration.
Conducting research of claims systems and system edits to identify issues and to audit claims adjudication for accuracy.
Performing pre-adjudication claims reviews (configuration testing) to ensure proper configuration was used.
Prepares correspondence to providers regarding coding and fee schedule updates.
Trains customer service staff on system issues.
Working with provider contracting staff when new/modified reimbursement contracts are needed.
Assisting with the analysis, documentation, configuration, and testing of current and future markets business requirements.
Supporting the upgrade of test environments
This position does offer flexibility in location for the right associate toWork@Home
Provider Reimbursement Admin Sr
/Requires/:
BA/BS degree
4-6 years related
Previous experience in care payer operations to include claims processing, claims auditing, claims testing and/ or claims research
Knowledge of one or more of the following claims paying systems; FACETS, AMISYS, NASCO, EZ-Cap, Rims, Ocare, Xcelys, NextGen, QNXT, ITS, IKA, WGS, Call Care Browser, GBAS, Genelco, HEALTHsuite, and Diamond
Direct experience in healthcare provider configuration and/or provider data management utilizing FACETS or one of the above listed systems
Must know how to read and analyze a contract (physician, ancillary and hospital)
Able to implement PCAs and load fee schedules
Able to use full range of Microsoft Office products proficiently
Leading or taking a primary role in the configuration of enterprise-class information systems/ software products in a highly regulated business environment
Experience in analysis and design of billing/ collection or similar applications and complex relational databases
or any experience or any combination of education and experience, which would provide an equivalent background.
//
/Preferred:/
Medicaid experience
FACETS specific pricing configuration build experience
FACETS NetworX experience
Able to run Microsoft Access queries in relation to Facets
Knowledge of CPT/HCPCS coding
Certified coder
Experience working with the implementation of new business in a health insurance industry setting
Project management experience
/We are ranked as one of America's Most Admired Companies among health insurers by Fortune magazine, and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at/ / ./ /EOE. M/F/Disability/Veteran./
Job Provider Network Management
Title: Provider Reimburse Admin Sr (Configuration Analyst Sr) nationwide #96755
Location: AZ-Scottsdate
Requisition ID: 96755 Estimated Salary: $20 to $28 per hour based on qualifications.
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