Anthem, Inc. Digital Products Director in Indianapolis, Indiana
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.
The Digital Products Director is a part of the dynamic Anthem Enterprise Data Science team, and will be focused on converting 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 must.
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 an BA/BS degree in Nursing, Business or Information Systems Management or related field of study and a minimum of 8 years experience or any combination of education and experience, which would provide an equivalent background.
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
Eight 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)
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
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. 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. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.