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Anthem, Inc. Manager II Grievance/Appeals in Smithfield, Rhode Island

Description

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 benefits companies and a Fortune Top 50 Company.

Manager II Grievance & Appeals

Norfolk, VA is preferred - will consider other Anthem office locations

Please note this position must be located in an Anthem office.

Responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to client/provider grievances/appeals and ensure compliance with regulatory requirements. Primary duties may include, but are not limited to:

  • Presents reimbursement coverage recommendations to Reimbursement and Clinical Policy Committees.

  • Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance.

  • Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines.

  • Addresses both internal/external customer/provider needs and concerns related to team activities.

  • Ensures programs support overall QI program and meet regulatory compliance/accreditation and the company standards.

  • Hires, trains, coaches, counsels, evaluates performance of direct reports, and other duties as assigned.

Qualifications

Requires:

  • 5 + years grievance & appeals experience and 3-5 years of management experience in the healthcare industry,

  • Extensive knowledge of healthcare industry coding theory, rules and standards (CPT, HCPCS, Revenue, ICD9, DRG, etc)

  • Ability to ensure organizational compliance with all required rules, policies, and procedures

  • AAPC or AHIMA coding licensure

  • or any combination of education and experience, which would provide an equivalent background.

  • BA/BS preferred

  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

REQNUMBER: PS37527-US

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