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Business Info Consultant - Richmond, VA or Atlanta, GA (136526)

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Reporting & Data Analysis
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136526 Requisition #
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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 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. 


As a member of the Program Integrity function within Health Care Analytics, the Concept Development team’s process is optimized to identify and avoid improper payments through effective review of claims post adjudication. Our goal is to deliver measurable cost savings primarily through cost avoidance and leads generation for overpayment recovery.

 

These jobs must be located at one of the following office locations and are not remote:
Richmond, VA or Atlanta, GA

We are currently seeking a Business Info Consultant to support the Concept Development and Prepay team within Anthem’s Health Care Analytics Unit. As a successful individual on this team, you will work with key business partners to accomplish assigned goals that may include, but will not be limited to, driving the identification, analysis and validation of cost avoidance and recovery opportunities with the goal of connecting one defect to others that may be related.This will be accomplished by analyzing concepts for recovery opportunities which could be provided by various departments such as Claims Payment Integrity, Health Plans, etc., data mining and researching all resources that support the identified concept. The incumbent would audit and analyze healthcare claim data and provides solutions to prevent, recover, correct, and implement solutions to complex Medicaid claims payment issues.


Responsible for serving as an expert in data analysis, reporting and formulating recommendations and providing guidance to other data analysts. As a successful individual on this team, you will work with key business partners as subject matter expert to accomplish assigned goals which may include but not limited to:

 

  • Generate leads which contribute to overpayment recovery and/ or cost avoidance.
  • Provide direction to data team for building queries to analyze complex data sets and identify Medicaid prepayment edits as well as overpayment trends and patterns.
  • Has technical and operational expertise.
  • Lead meetings and initiatives on very complex concepts with senior level executives and drive said projects to completion with minimal oversight.
  • Develops and executes complex data analysis and reporting.
  • Creates and develops partnerships with other departments including Health Plans, Claims, and Regulatory.
  • Successful individuals will benefit from a solid understanding of Anthem’s existing systems (Macess and FACETS, in particular), data warehouses, healthcare claims data analysis, and demonstrated experience and knowledge of healthcare insurance information (health claims data, procedure codes, diagnosis codes, physician specialty codes, etc.

 

 

Requirements
  • Requires a BS/BA degree in related field; minimum of 5 years experience; or any combination of education and experience, which would provide an equivalent background.
  • Experience with relational databases and knowledge of query tools and statistical software is required.
  • Ability to manipulate large sets of data.
  • Strong analytical, organizational, presentation, and problem solving skills.

This job is more focused on higher level technical expertise, mentoring staff 

in lower job levels, more customer facing, higher level of collaboration, work is higher volume and/or higher risk, and modeling as compared to the Bus Info Analyst Sr job. 

 


Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran

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As one of America’s largest health benefits companies, we at Anthem have a profound appreciation for service. Our organization proudly supports our nation’s active, reserve and veteran military service members and their spouses.

This is an exciting opportunity to advance your life and career, while still protecting and serving others. Come see for yourself why Anthem is recognized as a Top Employer by GI Jobs and among the “Best of the Best: Top Veteran Friendly Companies” by US Veterans Magazine.

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