Medical Review Analyst I - 40095SY - (US-VA-Richmond - 23298)

Minimum Education: Tech School
Job Type: Full Time
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THIS POSITION MAY BE LOCATED IN EITHER ROANOKE OR RICHMOND, VA

Anthem Blue Cross and Blue Shield
is a proud member of the WellPoint family of companies. At Anthem, we are dedicated to our mission of improving the health of the people we serve. We believe the best health care coverage can actually help people stay healthy.

Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

Responsible to provide non-clinical review and analsis of assigned non-complex Tier I post service medical claims. This is an entry level Medical Review Analyst position. Utilizes guidelines and review tools to analyze assigned claims and medical records to either approve or summarize and route to nursing and/or medical staff for review. Tier 1 work is subject to applicable accreditation and regulatory standards and requirements and as such the associates will strictly follow department guidelines and tools to conduct their reviews. Primary duties include, but are not limited to: Reviews, analyzes and renders determinations on assigned Tier I requests for review. May serve as a liaison between medical management and/or service operations and other internal departments. Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.

Skills:
Requires HS diploma, or equivalent, and 2 years of WellPoint claims or customer service experience, familiarity with medical coding and medical terminology, or any combination of education and experience, which would provide an equivalent background. Understanding of provider networks, the medical management process, WellPoint internal business processes, and internal local technology preferred. Chips, Amisys, Global 360, Maxcess and PCRS knowledge and experience preferred. WellPoint is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2008 DiversityInc magazine Top 50 Company for Diversity.

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