Anthem FACETS Provider Reimburse Admin- Medicare/Medicaid (122373) Open to USA Telecommuting in Denison, Texas

/Your Talent. 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 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.

As a member of A Medicare/ Medicaid/ or MMP(DUALS) pricing configuration team, you will play a part in assuring that our Health Plans in your team’s assigned market are able to provide the best possible service and care while maintaining our competitive advantage as an innovator in the Medicare/ Medicaid space—all while still operating profitably.

We are looking for experienced health plan configuration analysts at the Provider Reimbursement Admin level (Equivalent to most organizations’ Config Analyst II, Sr. or Lead; these roles do not have direct reports.) You will be evaluated throughout the selection process and offered the level that is most appropriate for you, based on your knowledge, skills, and abilities.

/Primary duties, for both positions, may include, but are not limited to:/

  • Reviewing individual provider contracts together with Anthem and CMS guidelines to ensure compliant and accurate configuration of critical information systems.

  • Analyzing each new provider contract for coverage, policy, reimbursement development, and implications for system edits. (May also perform CPT/HCPCS code and fee schedule updates)

  • Responding to system inquiries and appeals-- primarily in order to troubleshoot claims adjudication issues related to configuration.

  • Conducting research of claims systems and system edits to identify issues and to audit claims adjudication for accuracy.

  • Performing pre-adjudication claims reviews (configuration testing) to ensure proper configuration was used.

  • Prepares correspondence to providers regarding coding and fee schedule updates.

  • Trains customer service staff on system issues.

  • Working with provider contracting staff when new/modified reimbursement contracts are needed.

  • Assisting with the analysis, documentation, configuration, and testing of current and future markets business requirements.

  • Supporting the upgrade of test environments.

This position does offer flexibility in location for the right associate to Work@Home.

*Provider Reimbursement Admin *


BA/BS degree; 2-3 years related experience; or any combination of education and experience, which would provide an equivalent background.

/Demonstrated knowledge and experience in the following areas is required for the role and must be included in the related or equivalent experience to meet the basic qualifications listed above:/

  • Previous experience in care payer operations to include claims processing, claims auditing, claims testing and/ or claims research

  • Knowledge of one or more of the following claims paying systems: FACETS, AMISYS, NASCO, EZ-Cap, Rims, Ocare, Xcelys, NextGen, QNXT, ITS, IKA, WGS, Call Care Browser, GBAS, Genelco, HEALTHsuite, and Diamond

  • Direct experience in healthcare provider configuration and/or provider data management utilizing FACETS or one of the above listed systems

  • Must know how to read and analyze a contract (physician, ancillary and hospital)

  • Able to implement PCAs and load fee schedules

  • Able to use full range of Microsoft Office products proficiently

  • FACETS specific pricing configuration build experience required


  • Medicaid experience

  • FACETS NetworX experience

  • Able to run Microsoft Access queries in relation to Facets

  • Knowledge of CPT/HCPCS coding

  • Certified coder

  • Experience working with the implementation of new business in a health insurance industry setting

/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 EOE. M/F/Disability/Veteran./

Job Provider Network Management

Title: FACETS Provider Reimburse Admin- Medicare/Medicaid (122373) Open to USA Telecommuting

Location: TX-Denison

Requisition ID: 122373