Vacancy expired!
Quality EvaluatorLocation: United StatesNewRequisition #: PS32146YourTalent. 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.Responsible to monitor and evaluate the clinical
claim edit dispute process managed by external vendor.Primary duties may include,
but are not limited to:
Audits medical records andclaim information to determine accuracy of dispute management.
Provides writtenand/or verbal feedback to program staff to assist with performance improvementand staff development.
Develops reportingand overall performance trend identification.
Serves as thesubject matter expert in the areas of clinical and non-clinical policies andproceduresincluding coding standards.
Analyzesindividual and overall trends based on monitoring results and providingrecommendations to operations management or learning and Development.
Provides qualityreview process training.
Requires a BS/BAin nursing, social work, respiratory therapy or related clinical field; 3 yearsof experience in managed care to include experience in clinical staffdevelopment and education, quality; or any combination of education andexperience, which would provide an equivalent background.
Currentunrestricted license in applicable state(s) for designated field (i.e. RN,Social Work, Respiratory Therapy) required.
Clinicallyrelevant certification (i.e. Certified Diabetes Educator, Certified CaseManager) and a background in quality or performance improvement preferred.
Experience withClaims preferred.
Anthem, Inc. is ranked as one of America’s Most AdmiredCompanies among health insurers by Fortune magazine and is a 2018 DiversityIncmagazine Top 50 Company for Diversity. To learn more about our company andapply, please visit us at careers.antheminc.com. AnEqual Opportunity Employer/Disability/Veteran.
Vacancy expired!