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Provider Reimbursement Admin o...


Job Summary

Norfolk, VA
Other/Not Classified
Job Type
Full Time
Career Level
Experienced (Non-Manager)
Job Reference Code

Provider Reimbursement Admin or Sr. (Facets Configuration) Job Family PS2899

About the Job


Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater 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 Admin or Sr Job Family

We currently have five positions open, Norfolk, VA is the preferred location, Manager may consider telecommute.

The Provider Reimbursement Administrator or, Sr ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria for Implementation/Migration Projects. May serve as subject matter expert regarding reimbursement policies, edits, and coding conventions.

Primary duties may include, but are not limited to:
Performs system configuration by reviewing company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducts clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring policies and edits do not conflict with Federal and state mandates.
Works with other departments on claims adjudication workflow development and business process improvements.
May lead the full range of provider reimbursement activities for a state(s).
Leads projects related to provider reimbursement initiatives.
Serves as a mentor to less experienced administrators.
Works with provider contracting staff when new/modified reimbursement contracts are needed.


Requires a BA/BS degree;

BA/BS degree

A minimum of 3 years related experience; or any combination of education and experience, which would provide an equivalent background

FACETS experience required

Access experience required; the ability to query and build reports

Experience presenting data to various audience members at all levels preferred

Experience facilitating meetings preferred

Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.


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