Job Description
Ideal candidate must be flexible and willing to develop/share strategies to accomplish goals. Will work under the supervision of Anthem internal staff and designated lead in order to achieve goals and keep the project moving. Reviews require data analysis and research within client data systems.
Candidate will work with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base. If necessary, the medical record review is conducted on site in provider office or hospital institution. Local travel may be required. This candidate will be required to handle a high volume of telephonic interaction with provider offices. Candidates must follow up on requested medical records with providers. Must keep excellent documentation of research and contact information. Candidate must pass a medical record abstraction test prior to starting actual record reviews.
Essential Functions:
- This is a high production environment and candidates must adhere to measured productivity requirements, module testing and at times retesting to meet minimum requirements.
- Sharing of department responsibilities as assigned.
- Required to perform research on internal claims systems.
- Must be flexible and willing to develop and share strategies to accomplish goals.
- Work under the supervision of internal staff and designated lead in order to achieve goals and keep the project moving.
- Reviews require data analysis and research within the Anthem data systems.
- Candidates must have critical thinking skills as they will conduct research in a thoughtful and methodical search in order to locate specific claim information.
- Research includes all resources provided in order to find best information. Examples of deep dive research would be based on client specific platforms (i.e. Immunization registries, local claims system membership and defaulted claim information).
Qualifications
- Clear and active RN, LPN, or LVN license in the state of GA
- Licensed professional graduate of an accredited school of nursing
- They will be tested periodically on the accuracy of their abstraction and they must score at least 99%
- Strong research and analytical skills
- Experience with CPT-4, ICD-9 and ICD-10 DX coding
- Effective written, oral, and interpersonal communication skills
- Open to local travel and reliable transportation
Additional Information
Advantages of this Opportunity:
Competitive salary, negotiable based on relevant experience
Benefits offered, Medical, Dental, and Vision
Fun and positive work environment
Monday through Friday 8am-5pm
Company Description
Company is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With more than 73 million people served by its affiliated companies including nearly 40 million enrolled in its family of health plans, Anthem is one of the nation's leading health benefits companies.
One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.
We offer a broad range of medical and specialty products.