Anthem Business Consultant - Any Anthem Office or Remote (PS14411) in Denver, Colorado

Business Consultant - Any Anthem Office or Remote (PS14411)

New

Location: United States

Field: Business Support

Requisition #: PS14411

Post Date: 6 days ago

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.

Location: Any Anthem Office or Remote

Business Consultant

Responsible for Chargemaster compliance audits to identify Charge Description Master (CDM) violations.

Primary duties may include, but are not limited to:

  • Assist with creation of workflows and audit processes that are efficient and effective for new unit dedicated to Chargemaster compliance.

  • Assist with creation of policies, procedures and development of manuals, audit tools, and guidelines.

  • Completes analysis of complex reports and claims to evaluate CDM changes to assist with enforcing the CDM limits that have been negotiated in contracts.

  • Work with team to develop a database to catalog negotiated Chargemaster language provisions and related CDM thresholds.

  • Contact others to obtain any necessary information.

  • Completes and maintains detailed documentation of audit which includes decision methodology, system or processing errors.

  • Prepares appropriate written audit findings and recommendations for approval by the management team.

  • Leads and facilitates meetings to ensure the engagement with stakeholders.

  • Serve as a mentor and resource to other staff.

  • May lead teams of analysts assigned to the most complex projects, typically those of highest importance and impact to the way in which we do business.

  • Communication and handoffs between multiple functional areas of the organization (more commonly provider relations and HCA).

  • Interaction and coordination with external providers.

Requirements

  • 10+ years of related experience, which should include analysis, audit, project management, claims processing experience, experience as a Business Consultant with project management skills; or any combination of education and experience, which would provide an equivalent background.

  • Ability to travel may be required.

  • Strong research and problem solving skills.

  • Strong written, verbal and interpersonal communication skills required.

  • Good analytical and PC skills.

  • Must take initiative and be able to work on their own

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