, Virginia

Description

SHIFT: Day Job

SCHEDULE: Full-time

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.

As a Nurse Appeals, you will be responsible for investigating and processing appeals requests from contracted providers. Primary duties may include, but are not limited to:

 • Conducts investigations and reviews contracted provider appeals.

• Reviews medical records of denied services for medical necessity.

 • Extrapolates and summarizes medical information for medical director.

 • Prepares recommendations to either uphold or deny appeal and forwards to Medical Director for approval, when applicable.

 • Ensures that appeals are resolved timely to meet regulatory timeframes.

 • Documents and logs appeal information on relevant tracking systems and mainframe systems.

 • Generates written correspondence to contracted providers.

 • Utilize leadership skills and serves as a subject matter expert for appeals issues and is a resource for clinical and non-clinical team members in expediting the resolution of outstanding issues.

 

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. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.

Qualifications

  • Requires 3 – 5 years of clinical experience as a Registered Nurse.
  • Current active unrestricted RN license to practice nursing within the scope of licensure in applicable state(s) or territory of the United States required.
  • AS/BS in Nursing preferred
  • Preferred 2 years in a managed care healthcare setting - reviewing medical records, investigation, and/or processing appeals within a managed care setting; or any combination of education and experience, which would provide an equivalent background.
  • Prefer experience researching Medicare clinical guidelines: NCD, LCD; Medicare Benefit Policy.
  • Prefer experience reviewing claims and researching CPT codes or ICD-9 codes
  • Prefer experience with Facets, Macess, and ACMP

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. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 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.

, Virginia

If you’re a reserve or veteran member of the military, we foster a welcoming environment that’s dedicated to honoring your service and helping you achieve your career goals. Veterans of Anthem — one of our Business Resource Groups — partners with our Talent Acquisition teams to maximize career offerings for you and your family members, striving to help you transition to civilian service and grow your career at the same time. 

Join Anthem's Military and Veteran Talent Network: https://anthemcareers.ttcportals.com/pages/military 

WE ARE HIRING

Anthem, Inc. is currently seeking military veterans and military spouses with operations experience.  Whether your experience is hands-on as an operational specialist or in operational leadership, Anthem wants to have an impact on your career and professional growth by speaking with you about their career opportunities.

If you are interested in learning more, check out Anthem's current open positions to the right for more information and to apply today!

Not sure where to start?  Send RecruitMilitary Success Manager, Taylor Groves, your questions at taylor.groves@recruitmilitary.com 

 

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