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Anthem, Inc. Provider Reimbursement Director in Cincinnati, Ohio


SHIFT: Day Job

SCHEDULE: Full-time

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.

Provider Reimbursement Director

This position will be office-based open to any Anthem office location

The Provider Reimbursement Director will translate highly complex Government Business Division (GBD) pricing requirements into system requirements/configuration to support auto-adjudication. They will lead key provider reimbursement strategy, functions, and initiatives across the GBD and serve as a subject matter expert regarding provider reimbursement strategies and practices. Primary duties may include, but are not limited to:

  • Leads the development and implementation of GBD-wide provider reimbursement strategies, processes, and systems for a major provider type, such as facilities.

  • Works to drive the adoption and use of standardized reimbursement and contracting methodologies across GBD.

  • Works with medical directors, contract negotiators, cost of care staff and provider relations staff, and Pricing staff to identify and implement best practice solutions to manage costs and reimburse for services.

  • Facilitates the communication of activities, emerging trends, and best practices across all units and facilitates implementation of initiatives, through the use of a steering committee containing representatives from the company's plans, regions, and business units.

  • Researches and quantifies the impact of changes to reimbursement methodologies.

  • May lead fee schedule development for the specific plan(s) and/or the development and implementation of clinical editing rules.

  • Manages special projects and initiatives.

  • Represents the department and serves as a key contributor to GBD initiatives, projects, and task forces.

  • Creates and maintains comprehensive market pricing design documentation detailing configuration guidelines and standards.

  • Recognized as highly skilled in Facets Pricing, NetworX, Claims Processing, Enrollment, and Eligibility.


Minimum requirements:

Requires a BS/BA degree in a related field; 10 + years of business and professional experience in provider reimbursement and contracting, provider relations, provider servicing, claims processing, Facets pricing/NetworX configuration experience; or any combination of education and experience, which would provide an equivalent background.

Preferred qualifications:

10 or more years of configuration experience within Facets and NetworX

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 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.