Anthem, Inc. Physical Therapy or Occupational Therapy Therapist Reviewer in Indianapolis, Indiana
SHIFT: Day Job
Your Talent. Our Vision. At National Government Services (NGS), an independent subsidiary of Anthem, Inc. and one of the largest Medicare contractors in the country, it’s a powerful combination. It’s 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.
This unique opportunity for a Therapist Reviewer provides working in the Level III appeals area and attending scheduled hearings with OMHA judges. The Therapist Reviewer will be responsible for defending the claims decisions previously issued and educating administrative law judges on acceptable practice and policy, utilizing a combination of personal work experience and Medicare guidelines.
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 occupational therapy; 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 or occupational therapist in applicable state required.
Certification and/or licensure appropriate to field of specialty as required.
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.