Job Details

ID #19430898
State Virginia
City Richmond
Full-time
Salary USD TBD TBD
Source Anthem, Inc.
Showed 2021-09-09
Date 2021-09-10
Deadline 2021-11-08
Category Et cetera
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Digital Products Director

Virginia, Richmond, 23234 Richmond USA

Vacancy expired!

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. The Digital Products Director is a part of the dynamic Anthem Enterprise Data Science team, and will be focused on converting advanced AI-based insights into next-generation payment, coding, and clinical edits. He/she ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Serves as subject matter expert regarding reimbursement policies, edits, and coding conventions. He/she must possess good communication and writing skills, and attention to detail is a must. Primary duties may include, but are not limited to: - Read and analyze payer medical and payment policy, as well as provider contracts, translating into software edits, to ensure accurate claims payment Read and analyze Medicare/Medicaid data and policy, bulletins, manual updates, fee schedules, translating into software edits, to ensure accurate claims payment

Interpret and deliver business requirements for required software updates to ensure compliance with policy, contracting, regulatory changes or updates

Create detailed testing protocols for ensuring updates to software and edits delivered in accordance with requirements

Acts as a source of direction, training and guidance for less experienced staff.

Become increasingly familiar with Provider Payment systems such as DRG, APC, RBRVS

Qualifications Minimum requirementsRequires an BA/BS degree in Nursing, Business or Information Systems Management or related field of study and a minimum of 8 years experience or any combination of education and experience, which would provide an equivalent background.Knowledge of standard payment policy, medical policy, and payer and government regulations

Understanding of NCCI, MUE, Medicare PFS edits

Knowledge of medical terminology and anatomy

Preferred QualificationsEight years experience in health care coding, validation of appropriate procedures, diagnosis and additional codes used in medical billing

At least one of the following certifications strongly preferred: Certified Professional Coder (CPC, CPC-P, CPC- H), Certified Coding Specialist (CCS)

Ability to communicate effectively and collaborate with diverse internal and external stakeholder groups and individuals

Able to collect, research, and understand diverse information sets, and translate into clear and concise requirements

FACETS and/or WGS experience a plus

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: PS58106-Virginia

Vacancy expired!

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