Anthem Mgr. I Investigations - PS4161 in Mesa, Arizona

Mgr. I Investigations - PS4161

New

Location: United States

Field: Fraud

Requisition #: PS4161

Post Date: Apr 16, 2018

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: Preferred location is 5800 Northampton Boulevard, Norfolk, VA 23502

Working anywhere within the US remote is an option

Mgr. I Investigations

Manager I, Investigations for Concept Development Team within Enterprise Provider Education. Position will manage a team of certified professional coders in developing provider education concepts supporting CoC goals. Primary duties may include, but are not limited to:

  • Coordinates the analysis of provider utilization patterns and trends and of provider billing and financial data and manages the concept inventory..

  • Coordinates the review of concepts to ensure validity and applicability of data to ensure correct outlier identification.

  • Keeps abreast of changes in benefits, policies and regulations and in CMS performance standards and assists management in the interpretation of policies and procedures across all lines of business.

  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

  • Prioritizes/manages the Concept Development Team’s workload.

  • Identifies and prioritizes solutions which generate the greatest CoC return.

  • Become knowledgeable of the business goals, processes, and improvement opportunities.

  • Attention to detail is crucial.

EOE.M/F/Disability/Veteran

  • Requires BA/BS

  • 5+ years in investigations ; or any combination of education and experience, which would provide an equivalent background.

  • The Government requires that personnel working on Medicare Fraud investigations are U.S. Citizens.

  • Requires CPC certification

  • Prior Management experience a plus