Anthem (Facets NetworX) Provider Reimburse Admin Sr - PS 13591 (Any Anthem location or remote) in Andover, Massachusetts

(Facets NetworX) Provider Reimburse Admin Sr - PS 13591 (Any Anthem location or remote)

Location: United States

Field: Provider Network Management

Requisition #: PS13591

Post Date: Nov 28, 2018

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon whic 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.

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.

Primary duties may include, but are not limited to:

  • 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 experiencedassociatesAnEqualOpportunityEmployer/Disability/Veteran

Requires a BA/BS degree; 4+ yearsFacets NetworX pricing configurationexperience; or any combination of education and experience, which would provide an equivalent background.

The following are skills and experience that are a must have for this position.

  • Attend meetings and speak on Facets NetworX pricing configuration or alternatives

  • Train team on Facets NetworX pricing configuration and processes

  • Research complex Facets NetworX pricing configuration and inquiries

  • Develop Facets NetworX pricing designs for new pricing methodologies

  • Approve/disapprove contracts in Emptoris (pre-executed contracts), type up Contract Configuration Analysis form if required to clarify intent

The following are preferences for this position

  • Know how to run complex Access queries

  • Backend updates to Facets via Access

  • Ability to migrate configuration from test accounts to other test accounts and then to production

  • Know rate manger/winstrat (if exists in market)

Please note, we currently have one opening for this position which may be located in any Anthem site location or remote.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran