Anthem Manager Sr Financial Oper.Dept (Payment Integrity & Overpayment Recovery)-132818 in Santa Barbara, California

/ 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.

Manager Senior Financial Ops Dept ( Payment Integrity & Overpayment Recovery) may be at any Anthem location or telecommute.

The Manager Sr. Financial Operations Dept of Payment Integrity & Overpayment Recovery coordinates, directs and manages several units of varying complexity that has multi-state or multi-functional impact within Cost Containment. Manages the daily operations of a regional payment integrity team focused on identifying and recovering overpaid medical claims. The areas of focus for this role include but are not limited to: claim coding and billing, medical terminology, claims payment and recovery process, system configuration, and claims auditing.

Primary duties may include, but are not limited to:

  • Identifies and recovers overpaid healthcare claims.

  • Assists in the development and implementation of vision, strategies, and tactics to maximize the department’s effectiveness while minimizing costs.

  • Reviews statistical data of various systems in order to verify accuracy and timely processing.

  • Ensures internal controls are appropriate and develops policies and procedures and ensures compliance with government regulations.

  • Provides counsel to senior management.

  • Works with other areas for solutions to complex problems and participates in critical interactions with both internal and external customers.

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

  • Requires 7 years’ experience with operations, financial reporting and analysis, audit guidelines, budgeting and multi-state operations and processes; experience with complex business environments including multiple entity and highly automated situations; 5 years management experience; or any combination of education and experience which would provide an equivalent background. Bachelor's degree preferred.

  • Commercial Medicare/Medicaid experience preferred

  • Cost Containment/payment integrity experience preferred

  • Experience recovering overpaid Commercial Medicare/Medicare claims preferred

  • Healthcare experience required, managed care preferred.

/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 and apply, please visit us at// //. EOE. M/F/Disability/Veteran./

Job Accounting/Finance/Auditing

Title: Manager Sr Financial Oper.Dept (Payment Integrity & Overpayment Recovery)-132818

Location: california-Santa Barbara

Requisition ID: 132818