Anthem, Inc. Compliance Manager-MRA Coding/Clinical, RN preferred in Waukesha, Wisconsin
SHIFT: Day Job
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 care companies and a Fortune Top 50 Company.
Responsible for managing foundational and strategic compliance responsibilities with consistent excellence that support the team and management. The Manager will focus on provider audits by performing a review of documentation to ensure risk mitigation and compliance with the Centers for Medicare & Medicaid Services (CMS), ICD-10-CM coding guidelines, and medical record documentation requirements that will be used in developing, reviewing, and/or presenting documentation & coding training materials where appropriate.
Primary duties for this managing level position, with moderate to advanced complexity and broad/enterprise scale may include, but are not limited to:
Manage/oversee projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness.
Review of Medicare Advantage member medical record documentation
Serve as coding subject matter expert to internal and external stakeholders
Create/Present educational material on documentation & coding for Medicare Risk Adjustment purposes
Establish project plans, gap analysis, milestone dates, and other significant aspects, and leadership updates.
Maintain knowledge of laws, regulations, company strategies to assess impact, and consult with clients as subject matter expert.
Conducts complex investigations, document findings, and ensure corrective actions are made. Interface with external clients, regulators, vendors, supplier; internal stakeholders, high level of management.
Requires a BA/BS and minimum of 6 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background. Ability to travel may be required.
MS/MBA/JD or professional designation preferred.
Coding certification (e.g., Certified Coding Associate or Certified Professional Coder) from an accredited source (e.g., American Health Information Management Association or American Academy of Professional Coders) preferred.
Certified Risk Adjustment Coder – a plus.
CDEO certification and/or RN experience strongly preferred.
5+ years of experience of relevant coding and/or medical record audit experience. (Audit experience can be in a physician’s office, hospital or insurance office setting.)
Experience developing educational materials is preferred.
Medicare Risk Adjustment experience preferred.
Proficient with MS Office applications: Word, PowerPoint, Excel preferred.
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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. 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. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.