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.
Medical Record Audit and Training Consultant (PS28150)
Office-based; Miami, FL, Travel within Miami-Dade county
Responsible for evaluating and auditing physician and hospital medical records and medical assessment forms to ensure compliance with federal guidelines and medical documentation requirements.
Primary duties may include, but are not limited to:
- Serves as final auditing arbiter regarding the Risk & Recovery's Retrospective Risk Adjustment (RA) Coding Team. Identifies training opportunities for internal and external stakeholders related to federal guidelines, best practices, and medical record documentation requirements.
- and analyzes data to formulate recommendations and solutions based on audit trends and results.
- Provides feedback to Risk & Recovery leadership on performance improvement opportunities as a result of performance gaps.
- Acts as a subject matter expert to internal and external stakeholders in the area of federal requirements and best practices.
- Participates in and represents the department in business leadership groups, including external professional groups specializing in coding and provider education.
- Assists the business with research and documentation of workflows and policies and procedures.
Ø Strong Auditing experience
Ø Coding experience
Ø Travel up to 50% of the time
Ø Clinical experience, Nursing license
Ø Medicare experience
Requires BA/BS in health sciences, health management, or nursing; 5 years of ICD-9 coding or medical record audit experience in a consultative role; or any combination of education and experience, which would provide an equivalent background. CPC from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) and CPMA (Medical Auditing Certification) from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) or equivalent certification required.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.