Posted in Management 30+ days ago.
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Location: Fond du Lac, Wisconsin
Anthem, Inc. is the nation's leading health benefits company serving the needs of approximately 40 million medical members nationwide.
Works with participating providers to resolve reimbursement issues/questions.
Primary duties may include, but are not limited to:
- May maintain reimbursement data for the accurate processing of claims.
- Reviews suspended claims and makes reimbursement determinations.
- Responds to back end review inquiries to resolve pricing issues.
- Coordinates the process flow of claims from operations to the reimbursement area to accurately and in a timely manner price the claims.
- Identifies procedures to price and then develops a price for procedures in order to facilitate automatic pricing.
- May accompany provider relations representatives on provider calls when provider questions the rationale behind payments.
- Requires a H.S. diploma;
- or any combination of education and experience, which would provide an equivalent background.
- 3-4 years managed care experience in the area of provider relations or claims/customer service preferred.
- 2 years of Facets experience required
Anthem, Inc. is ranked as one of America’s 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.