Job Details

Provider Reimbursement Administrator – Operations (128499 KT)

Provider Network Management
VA-Norfolk, United States, WI-Waukesha
August 8, 2017


Anthem Inc., is one of the nation’s leading health benefits companies and a Fortune Top 50 company. At Anthem, Inc., we are working together to transform health care with trusted and caring solutions.

Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives and to take your career further than you can imagine.

Provider Reimbursement Administrator (Operations)

The incumbent is responsible to:

Communicate medical policies, reimbursement policies, and clinical editing policies education to providers.

Interpreting and applying National Uniform Billing Compliance rules, guidelines, laws and industry trends to support ongoing provider education.

Primary duties may include, but are not limited to:

  • Reviews Anthem specific, CMS specific, and competitor specific medical policies, reimbursement policies, coding guidelines and editing rules, as well as conducts research, data analysis, and provider identification to further understand and explain education opportunities.
  • Assist with preparation of written communications to providers
  • Research and respond to provider inquiries
  • Review providers with aberrant billing practices and interpret claims data for provider feedback
  • Interface with local Health Plan representatives regarding provider education initiatives
  • Correspond with providers (telephone, email, fax, USPS) regarding correct coding practices.
  • Follow timeline of release for mailing provider education letters.
  • Performs other duties as assigned.

The preferred location(s) for this position

Concourse location 5800 Northhampton Blvd in Norfolk VA (If within 60 miles of office, will be required to train or work in office based on needs of the department)

N17 W24340 Riverwood Drive (Pewaukee) Waukesha, Wisconsin 53188 (If within 60 miles of office, will be required to train or work in office based on needs of the department)

This position does offer the work from home option anywhere within the US.

The department is open Monday – Friday 7 AM to 6 PM EST (must be able to work an eight hour shift within this timeframe)


  • BA/BS degree in Health Care Management, Accounting or Business
  • 3 years coding experience in a health care setting (ICD-10, CPT-4, E&M, HCPCS);
  • or any combination of education and experience, which would provide an equivalent background.
  • Experience in health insurance reimbursement, medical billing, medical coding, auditing
  • Requires strong oral and written communication skills
  • Ability to manage multiple tasks in a demanding work environment,
  • Appreciation of cultural diversity and sensitivity towards target membership population,
  • High energy level, self-motivating and able to handle several projects at a time
  • Experience with Microsoft Outlook and Excel
  • Strong computer experience able to toggle back and forth through multiple screens


  • CPC certification strongly preferred.
  • Previous experience auditing professional and/or facility coding preferred.
  • Experience with MicroSoft Access, PowerPoint strongly preferred
  • Previous work from home experience.

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 please visit us at EOE. M/F/Disability/Veteran.

*WARNING : Please beware of phishing scams that promote work-at-home opportunities and which may also pose as legitimate companies. Please be advised that an Anthem recruiter will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for a role with our company. All of our careers require that you first complete an online application.