Anthem, Inc. Physical Therapist Reviewer in Cary, North Carolina
SHIFT: Day Job
Your Talent. Our Vision. At Healthy Blue, a strategic alliance of Blue Cross NC and Amerigroup, an Anthem Inc. company, 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 healthcare.
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 benefits companies and a Fortune Top 50 Company.
The Physical Therapist Reviewer is responsible for performing medical record reviews specific to services billed related to physical therapy with adherence to all contract requirements, ISO processes and operational unit goals to ensure customer satisfaction. Primary duties may include, but are not limited to:
Conducts medical review/claim review of beneficiary health records specific to therapy services in support of investigations, cases, law enforcement requests and other activities.
Documents findings, develops, analyses and submits necessary reports to the appropriate departments in accordance with regulations and requirements.
Codes and prices complex claims using ICD-9, HCPCS and CPT manuals and coding guidelines when necessary as it relates to therapy services.
Researches and obtains additional data, when necessary.
Acts as a resource for internal and external customers.
Maintains productivity standards and ensures reviews are conducted within required timeframes.
BA/BS in physical therapy: 3 years clinical experience; or any combination of education and experience, which would provide an equivalent background.
Current licensed physical therapist in applicable state required.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.