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Network Reimbursement Specialist - Indianapolis, IN/Fond Du Lac, WI - PS26525 at Anthem, Inc.

Posted in Management 30+ days ago.

This job brought to you by eQuest

Type: Full-Time
Location: Fond du Lac, Wisconsin





Job Description:

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.