Network Reimbursement Specialist (Mason, OH or Louisville, KY) - - (US-KY-Louisville - 40299)

Minimum Education: Tech School
Job Type: Full Time
Email this job to yourself or to a friend | Job Match Test | Resume Guide

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.

Network Reimbursement Specialist

Responsible for working with participating providers to resolve reimbursement issues/questions. May maintain reimbursement data for the accurate processing of claims.
Review suspended claims based on correct coding guidelines, medical record and Anthem Central Region's Reimbursement Policies and Procedures and make determination if claim line is reimbursable. Responds to back end review inquiries based on correct coding guidelines, medical record and Anthem Central Region's Reimbursement Policies and Procedures from Provider Inquiry, Provider Relations and Customer Service to resolve pricing complaints for modifiers, rebundling and complicated surgeries. Coordinates the process flow of claims from operations to the reimbursement area to accurately and in a timely manner price the claims. Facilitates automatic pricing by looking for ways to reduce the claims coming from operations by identifying procedures to price and then developing a price for procedures in order to facilitate automatic pricing in the claims processing units. Assist Provider Relations representatives on provider visits or calls when provider questions rationale behind payment from Anthem. Also available for deposition when provider challenges Anthem determinations. Performs other duties as assigned.

Skills:
* H.S. diploma or an equivalent combination of education and experience required.* Knowledge of medical terminology preferred.* 3-4 years managed care experience in the area of provider relations or claims/customer service preferred.* Highly advanced written and oral communication skills required.* Good PC skills, problem-solving skills required.* In-depth knowledge of specialized area preferred.* CPC certified or meeting requirements to take CPC certification exam is preferred. * Prefer candidates with at least 2 years of experience as a coder or practice manager.* 10% travel is required. WellPoint is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2009 DiversityInc magazine Top 50 Company for Diversity.

To apply copy and paste the link below into your browser:

http://hispanic-jobs.com/view.php?job_id=81122&type=search&auth_sess=uj93vaq4g6fkravsggqetal471&ref=436919cfbdb3c050605681eb7

There are so many more positions in any industry in all cities and states available on our website. Hispanic-Jobs.com specializes in jobs for bilingual English/Spanish-speaking professionals and applying to all jobs is free. Take a look, there are many wonderful opportunities available. Go directly to www.Hispanic-Jobs.com