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.
Responsible for the clinical documentation improvement and chart / coder audit efforts for the Medicare Advantage members in California, Nevada, Arizona and Virginia among other states.
Primary duties may include, but are not limited to:
Oversees daily operations of the CDI specialists and auditors, retrospective and prospective review teams and programs and ensures the appropriate strategy, tactics and data capture processes are in place.
Serves as the vendor and provider liaison to ensure coordination of efforts, effective relationship management, cost effectiveness, delivery of work product, quality of work, delivery of required training for internal associates and timely communication on all issues.
Collaborate closely with the clinic, market, network leadership teams to implement risk adjustment education, processes and programs effectively for accurate and compliant capture of members’ conditions.
Provide Education and feedback to the providers on a regular basis.
Engage with large IPAs leadership and CMOs for effective collaboration of processes and data exchange Engages with enterprise functional areas to optimize identification of members with HCC conditions, facilitates efficient and effective interventions to ensure accurate and complete coding, and ensures at risk members are referred to or engaged in care management programs.
Audits the chart review outcomes provided by the risk adjustment vendor and audits provider coding trends to identify potential gaps.
Works with PE&C to facilitate gap closure and consults on efforts that may improve provider engagement.
Serves as a key member of the Risk Adjustment Management team in developing processes for multidisciplinary, matrixed teams to execute the strategic vision and achieve the goals and objectives of the organization related to revenue optimization.
In consultation with VP of the Revenue Maximization team and Health Care Analytics, develops state specific strategies and communicates recommendations to plan presidents.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires a BA/BS degree in a related field.
Clinical experience or background (e.g.
MD, NP, RN, LPN, foreign medical graduates) required.
A minimum of five years of experience with Medicare or Medicaid risk adjustment processes, provider and vendor management experience, and 8-10 years of leadership experience including management of virtual teams; or any combination of education and experience, which would provide an equivalent background.
Demonstrated in-depth Risk Adjustment subject matter expertise
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc.
has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes.
To learn more about our company and apply, please visit us at careers.antheminc.com.
An Equal Opportunity Employer/Disability/Veteran.
Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.
Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem.
Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem.
Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.
EEO is the Law
EqualOpportunityEmployer/Disablity/Veteran
Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
Anthem, Inc.
is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs.
If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance.
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