Anthem, Inc. Provider Reimburse Mgr in Modesto, California
SHIFT: Day Job
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 care companies and a Fortune Top 50 Company.
Provider Reimburse Mgr
Manages key components of the provider reimbursement strategy.
50% Required Travel
Primary duties may include, but are not limited to:
Leads fee schedule development for specific plan(s) and/or the development and implementation of clinical editing rules.
Leads and develops specific plans for the implementation of clinical reimbursement editing rules.
Works with the Provider Manual Committee and the Payment Integrity Team to ensure that accurate cost of care targets are incorporated into the company's financial planning.
Provides analytical support for hospital and physician negotiations.
Provides analytical support for the Payment Integrity Team.
Prepares and presents cost of care data analysis to support the regions cost of care initiatives.
Develops and maintains the provider reimbursement strategy that will lower the cost of care and reduce administrative expenses.
Manages special projects and initiatives.
- Requires a BA/BS degree in a related field and a minimum of 7 years reimbursement experience including performing detailed financial modeling and economic analyses; or any combination of education and experience, which would provide an equivalent background.
Nursing background strongly preferred
Experience in Hospital Bill Auditing strongly preferred
BSN, MBA, CPA, MGA or other equivalent advanced degree strongly preferred.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.