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Description SHIFT: Day JobSCHEDULE: Full-timeYour 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 care companies and a Fortune Top 50 Company. Location: This position will allow you to work from your home office, anywhere in the US. You must be able to work Eastern and Central Standard Time Zones – regular business hours. Job Description: Responsible for translating basic business needs into application software requirements.
Primary duties may include, but are not limited to: Analyzes business needs to determine optimal means of meeting those needs.
Determines specific business application software requirements to address specific business needs.
Works with programming staff to ensure requirements will be incorporated into system design and testing.
Acts as liaison with users of the software to address questions/issues.
Analyzes complex end user needs to determine optimal means of meeting those needs.
Develops project plans and identifies and coordinates resources, involving those outside the unit.
Works with programming staff to ensure requirements will be incorporated into system design and testing.
Performs QA checks, reconciles and validates encounter data.
Analyzes and audits files submitted by vendors (i.e. CDJ/837/claims detail file) to determine if services were appropriate and payment to vendor is warranted.
Works directly with vendors to resolve any open data issues and/or discrepancies found during the performance of a periodic reconciliation.
Performs prepayment review to ensure vendors are billing according to state specific requirements, as well as fee schedule audits
Qualifications Job Qualifications:Requires a BA/BS and minimum of 3 years related business analysis experience, or any combination of education and experience, which would provide an equivalent background.
SharePoint experience as a power user who can provide some out of box solutions.
Familiar with EDI 834 and 837 testing and analysis
Ability to run SQL queries
Some Knowledge Management experience preferred
For URAC accredited areas, the following professional competencies apply:
Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position¿ work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions.
Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
REQNUMBER: PS61294
Vacancy expired!