🌎
This job posting isn't available in all website languages
📁
Provider Network Management
📅
PS24693 Requisition #
Your 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 healthcare. 

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 Auditor Sr - PS24693
Location:  Off Premises Work and local in Cerritos, CA.

Performs reviews of medical charts, medical notes, itemized bills and providers contracts to ensure that a claim is paid in accordance with the contract, provider reimbursement policies, and industry standards. 
  • Primary duties may include, but are not limited to:  
    • Assists in identifying providers to be reviewed based on historical results of other reviews with providers, network management input and dollar volume of provider. 
    • Assists with virtual review with provider, analyzes data to select claims to be reviewed, conducts review using medical charts, medical notes, itemized bills and provider contracts.  
    • Conducts exit interview with provider management team by presenting preliminary review results. 
    • Verifies dollar amount on claim is correct in claims system and writes report of the findings of the review and requests payments for any overpayments. Identifies aberrant patterns of billing and detects potential abuse. o Mentors and trains Provider Auditor as needed. 
    • Drafts department policies and procedures and other educational materials.  Works on task forces and committees representing functional area.

Qualifications:


Requires either a BA/BS degree or Registered Nurse;

  • Certification in a clinical practice or medical coding or provider reimbursement auditing or 5 years equivalent work experience; or any combination of education and experience, which would provide an equivalent background.
  • RN or medical coding certification preferred.
  • At least 25% travel required (to Cerritos, CA if the associate is WAH).
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com.

AnEqualOpportunityEmployer/Disability/Veteran

Previous Job Searches

Activity Feed

29009
Job shares through Anthem, Inc.
kevin petteys referred the Senior .NET Developer position. 3 days ago
Rabindra Gaan referred the Dir I Technology - Data Strategy and Governance - PS20256 position. 6 days ago
Srivalli Budaraju referred the Pharmacy Program Consultant or Manager (job family) (PS28517) Any Anthem location position. Oct 08, 2019
Rabindra Gaan referred the Dir I Technology - Data Strategy and Governance - PS20256 position. Oct 02, 2019
Tiffany Lee referred the Provider Network Manager I - California - PS27407 position. Oct 02, 2019

Metrics & Data

Leverage your talents to make a difference in people's lives, by providing innovative, data-driven solutions that can measure and improve consumer's health.

Anthem metrics and data associates focus on creating innovative, data-driven solutions that can measure and track progress in our members’ health. Collaborate with internal and external experts to develop metrics-supported strategies for improving measurements and processes.

Enable physicians and hospitals to improve care with valuable information that improves care quality and affordability. Join us and help provide tools to help consumers make better decisions, as we create a simpler, more affordable, more accesible healthcare system.

Metrics and data associates at Anthem:

  • Develop statistical models and functional means for measuring the quality of health care members receive annually
  • Provide members with useful, powerful tools for self-evaluation and tracking of health issues and risk factors
  • Show initiative and make key decisions with the potential to dramatically influence patient outcomes and positively impact peoples' lives
  • Create thoughtful solutions that engage and empower members to make more informed decisions about their health and health care
  • Serve as a catalyst to improve the essential relationship between patient and health care provider
  • Leverage metrics and data to deliver resources that help overcome traditional coverage barriers such as education, literacy and language

View Related Jobs