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Provider Reimbursement Manager-PS31626Location: Norfolk, Virginia, United StatesNewRequisition #: PS31626Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re 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.Provider Reimbursement Manager-RemoteManages key components of the provider reimbursement strategy for Medicare & Medicaid Implementations. 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.
Works with the Health Service Area, actuarial, decision support, and underwriting to ensure that accurate cost of care targets are incorporated into product pricing.
Performs and/or directs complex fee modeling exercises to ensure that projected unit reimbursement changes meet corporate cost targets.
Provides analytical support for hospital and physician negotiations.
Reviews state regulations and rate documents for initial fee schedule structure configuration.
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.
Supervises team of Pricing Reimbursement Analysts for configuration design.
Serves as subject matter expert in state mandated and internal End-to End testing.
Participates in proposing configuration solutions for complex regulatory requirements.
Provides ad-hoc analysis and support performing complex queries using relational data base Microsoft Access or SQL
Requires:
BA/BS degree in a related field
7+ years Trizetto Facets NetworX Pricer configuration experience
Optum Rate Manager configuration experience preferred
or any combination of education and experience, which would provide an equivalent background.
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.
Vacancy expired!