Provider Escalations Analyst

Description

Provider Escalations Analyst

New York, Connecticut, Maine & New Hampshire          

Be a part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.  You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change.  Do you want to be a part of a larger purpose and evolving, high-performance culture that empowers you to make an impact?

The Provider Escalations Analyst is responsible for Provider Issues Resolution (PIR) escalations across all lines of business and is responsible for the resolution of provider payment escalation requests and communication of contracts along with medical and clinical policies.

Primary duties include but are not limited to:

• Remediate impacted high dollar multi claim issues (request and analyze claim impact reports & initiate sweeps), investigate the outcome of claim payment or denial, adjusts complex claims for a specific line of business and market, adjust voids, rekey and reopen claims on-line within guidelines to ensure proper adjudication, interpret benefits, policies and procedures, provider contracts, and adjudication of claims, analyze systems and processes that span across multiple operational area and claim systems, recommend resolution for contract dispute, non-routine claim issues, billing questions and other practices, identify barriers and facilitates process improvement projects and coordinates communication processes on medical policy, reimbursement, and provider utilization patterns.
• May serve as a liaison and SME with internal and external business partners.
• Collaborates with internal and external business partners to determine root cause and solve for appropriate resolution.

Qualifications

Minimum Requirements:

• Requires a high school diploma or GED.
• Requires a minimum of 6 years of claims research/customer service experience and/or issue resolution or analysis of reimbursement methodologies within the health care industry; or any combination of education and experience, which would provide an equivalent background.

Preferred Requirements:

• CS90, Kernel, WGS, claims experience 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 Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. 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 age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.