Anthem Dental Quality Configuration Audit Associate - Eagan, MN, Gilbert, MN, or Colorado Springs, CO - PS6207 in Colorado Springs, Colorado

Dental Quality Configuration Audit Associate - Eagan, MN, Gilbert, MN, or Colorado Springs, CO - PS6207

Location: Eagan, Minnesota, United States

Field: Quality

Requisition #: PS6207

Post Date: 5 days ago

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 healthcare .

This is an exceptional opportunity to do innovative work that means more to you and those we serve atone of America's leading health benefits companies and a Fortune Top 50 Company.

Responsible for drivingservice quality excellence by evaluating the quality of services and interactions provided by organizations within the enterprise. Included are processes related to benefit,coding, and rulesconfiguration and respective downstream processes, as well as provider inquires.

Primary duties may include, but are not limited to:

  • Assists higher level auditor/lead onwork as assignedand acts project manager on small and less complex audits.

  • Participates in pre and post implementation audits of providers, claims processing and payment, benefit coding, member and provider inquiries, enrollment & billing transactions andrecommendations forthe corrective action plan process.

  • Demonstrates ability to audit multiple lines of business, multiple functions, and multiple systems.

  • Analyzes and interprets data and makes recommendations for change based on judgment and experience, applies audit policy, and assesses risks to minimize our exposure and mitigate those risks.

  • Works closely with the business to provide consultation and advice to management related to policiesand proceduresidentified as out of date or incomplete and investigates,and recommends process improvements and solutions.

  • Functions as a subject matter expert for discrepancy review, questions from team and business partners, and interpretation of guidelines and audit process.

  • Acts as a mentor to peer auditors, providing training and managing work and projects as necessary.

  • Requires a BS/BA;

  • 3+ years’ experience in claims operations or related auditing and configuration;

  • 3+ years' medical or dental claims processing experience including a minimum of 1 year related experience in an audit capacity (preferably in healthcare or insurance sector) with consistent above target performance;

  • Or any combination of education and experience, which would provide an equivalent background.

  • Claims processing experience is required.

  • Proficiency in Microsoft Word, Excel and Outlook is required.

  • Working knowledge of insurance industry and dental terminology preferred.

  • Detailed knowledge of claims and / or enrollment systems and proven understanding of processing principles, techniques and guidelines.

  • Ability to acquire and perform progressively more complex skills and tasks in a production environment.

  • Medical or Dental auditing experience is preferred.

  • Medicaid and Medicare knowledge is preferred.

  • WDS, CLEAR, DDS experience is preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at EOE. M/F/Disability/Veteran.