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Bus Info Developer Cons Sr

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Job Details
Job Order Number
Company Name
Anthem, Inc
Physical Address

Westchester, IL 60154
Job Description


SHIFT: Day Job

SCHEDULE: Full-time

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.

Bus Info
Developer Cons Sr (PS39179)

Location: Must
be within reasonable driving distance of an Anthem office.

The Bus Info Developer Cons Sr is a part of the dynamic Anthem Enterprise
Data Science team, and will be focused on convert advanced AI-based insights
into next-generation payment, coding, and clinical edits. He/she 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. He/she must
possess good communication and writing skills, and attention to detail is a

Primary duties may include, but are not limited to:

+ Read and analyze payer medical and payment policy, as well as provider
contracts, translating into software edits, to ensure accurate claims payment

+ Read and
analyze Medicare/Medicaid data and policy, bulletins, manual updates, fee
schedules, translating into software edits, to ensure accurate claims payment

+ Interpret and
deliver business requirements for required software updates to ensure compliance
with policy, contracting, regulatory changes or updates

+ Create detailed
testing protocols for ensuring updates to software and edits delivered in
accordance with requirements

+ Acts as a
source of direction, training and guidance for less experienced staff.

+ Become
increasingly familiar with Provider Payment systems such as DRG, APC, RBRVS

Requires a BS/BA degree; 5 years experience; or any combination of education
and experience, which would provide an equivalent background.

+ 5 years experience in health care coding, validation of appropriate procedures,
diagnosis and additional codes used in medical billing

+ At least one of
the following certifications strongly preferred: Certified Professional
Coder (CPC, CPC-P, CPC-H), Certified Coding Specialist (CCS)

+ Knowledge of
standard payment policy, medical policy, and payer and government regulations

+ Understanding
of NCCI, MUE, Medicare PFS edits

+ Knowledge of
medical terminology and anatomy

+ Ability to
communicate effectively and collaborate with diverse internal and external
stakeholder groups and individuals

+ Able to
collect, research, and understand diverse information sets, and translate into
clear and concise requirements

+ FACETS and/or
WGS experience a plus

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 An Equal Opportunity Employer/Disability/Veteran.


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