Anthem, Inc. Therapist Reviewer in Houston, Texas
SHIFT: Day Job
Your Talent. Our Vision. At Amerigroup, a proud member of the Anthem, Inc. family of companies focused on serving Medicaid, Medicare and uninsured individuals, it’s a powerful combination. It’s the foundation upon which 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.
Location: Houston, TX or Dallas, TX The person in this role must work in our Houston, TX or Dallas, TX office for the first 90 days. After 90 days, remote work may be an option.
The Physical Therapy Assistant Reviewer is responsible for the review of medical records to determine if requests for therapy services (physical therapy, occupational therapy, and/or speech-language pathology) were medically necessary and filed appropriately. Primary duties may include, but are not limited to:
Applies professional therapy, government regulation, and medical policy knowledge to medical review, and makes determinations for authorization requests, meeting all contract requirements, processes and operational unit goals to ensure customer satisfaction.
Documents findings, develops analyses, and submits reports to the appropriate departments in accordance with government regulations and requirements.
Researches and obtains additional data, consults with clinical reviewers and medical directors, when necessary.
Acts as a resource for internal and external customers.
May participate in intradepartmental teams, projects and initiatives. Maintains quality and productivity standards, and ensures reviews are conducted within required timeframes.
Requires a graduate of a college level program in physical therapy or an accredited two year program for a Physical Therapist Assistant; 1 year of clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current active unrestricted license or certification as a physical therapist assistant in applicable state required.
Certification and/or licensure appropriate to field of specialty as required.
5 years of clinical experience highly preferred.
Previous pediatric experience preferred.
Home Health experience preferred.
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. An Equal Opportunity Employer/Disability/Veteran.