Anthem Medical Policy Regional Coordinator- 132523 in Denison, Texas


Anthem, Inc.is one of the nation's leading health benefits companies and a Fortune Top 50 company. At Anthem, Inc., we are working together to transform health care with trusted and caring solutions. Bring your expertise to our innovative culture where you will have the opportunity to make a difference in people’s lives, and to take your career further than you can imagine.

Prefer this position be located in the North East, but may work from any location or work from a home office.

Medical Policy Regional Coordinator-OMPTA Responsible for serving as a liaison and quality resource between The Office of Medical Policy and Technology Assessment (OMPTA) and multiple regional/health plan business operation areas. Primary duties may include, but are not limited to managing or assisting with the management of the following: 1) External independent clinical appeal review, entry, and reporting of overturn information related OMPTA documents to researchers and leadership; 2 ) facilitate the medical policy claims implementation self audit process including preparing the audit sample and assigning the related medical policies based on the CPT/HCPCS codes; tracking, trending and reporting claim audit results to goal by claims platform to leadership and tracking completion of business area corrective action plans; 3) facilitate/coordinate and organize the agenda, materials, and minutes for at least one clinical and/or business committee. 4) Duties may also include, but are not limited to: a) Research and respond to Medical Policy inquiries in coordination with the research team as well as log, track, trend and report on Medical Policy inquiries and responses. b) Participate in quarterly Medical Policy upload QA audits. c) assist with access database updates and data entry as needed; d) Support Ad hoc projects and initiatives as needed. e) Other duties as assigned.

Requires a BA/BS in a related field; 5 years of related experience; or any combination of education and experience, which would provide an equivalent background. RN preferred. Must be proficient with Word and Excel with demonstrated ability to utilize Microsoft office tools to analyze and manage large volumes of information on a daily basis. Experience in analyzing data and in conducting audits to identify patterns and trends and overseeing corrective action plans in a quality or clinical environment. Experience with editing document content and highly complex medical information and/or quality or regulatory processes is required. Anthem medical policy experience is strongly preferred. Task oriented individual with a strong attention to detail and a demonstrated ability to independently focus and manage multiple complex and technical tasks in a fluid environment.

/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, and is a 2014 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.__/

Job Medical

Title: Medical Policy Regional Coordinator- 132523

Location: texas-Denison

Requisition ID: 132523