Anthem Business Consultant Sr. RN Coder Pharmacy PS21360 in Indianapolis, Indiana
Business Consultant Sr. RN Coder Pharmacy PS21360
Location: Atlanta, Georgia, United States
Requisition #: PS21360
Post Date: May 20, 2019
YourTalent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive thefuture 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.
Please note; we currently have one opening for this position. Preferred on site locations are: Atlanta, GA, Richmond or Norfolk, VA. However, will consider a remote position for ideal candidate but must live within reasonable commuting distance from an Anthem primary location.
The Senior Business Consultant will be an individualcontributor reporting to the Clinical Director within the Product & EfficiencyDepartment for Program Integrity, an enterprise function within Anthem’sDiversified Business Group (DBG). Thesuccessful candidate will work with the Clinical Director of Product andEfficiency and other teams to include Quality Code Review, SpecialInvestigations, Data Mining and Advanced Analytics on Clinical Initiatives.
This position requires an understanding of how to conduct fraud, waste and abuse investigations with the clinical expertise to evaluate documentation and coding practices compared to guidelines, and then design clinical and coding review programs to efficiently and effectively conduct provider audits. Ideally the individual with have deep understanding ofbothpharmacy and medical claims and documentation and coding practices.
Responsible for translating complex clinical and business needs in process/workflow and application requirements.
Primary duties may include, but are not limited to:
Provides expertise across the PIbusiness operating as an internal consultant leading and/or supporting analysisof business needs to determine optimal means of meeting those needs.
Determines specific businessapplication software requirements to address the most highly complex and variedbusiness needs.
May lead teams of analysts assignedto the most complex projects, typically those of highest importance and impactto the way in which we do business.
Analyzes and designs solutions toaddress varied and highly complex business needs.
Requires a BS/BA degree, 10 + years of business analysis experience, which should include business analysis, clinical knowledge and coding experience in medical and pharmacy, project management experience;
3 + years experience as a BusinessConsultant with project management skills; or any combination of education andexperience, which would provide an equivalent background.
Bachelors or Masters in Nursing oran RPH preferred.
Coding experience and certificationsa strong plus.
Ability to travel maybe required –25%.
Anthem, Inc.is ranked as one of America’s Most Admired Companies among health insurers byFortune magazine and is a 2018 Diversity Inc magazine Top 50 Company forDiversity. To learn more about our company and apply, please visit us atcareers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.