Process Expert I

Company: Anthem, Inc.
Location: Miami
Posted on: February 25, 2021

Job Description:

Welcome to the Anthem Careers site! We have been hard at work to improve our job search and application systems to better serve you. It is now easier to find and apply for relevant jobs as well as stay connected with Anthem. Here are a few of the updates you may notice:

• No more profiles! We no longer require you to create a log in and password to apply for a job and you won't be able to access previously created profiles, but don't worry - we still have your previous application(s) on file and you can still track your status by clicking on the "Track Your Job Application Status" button.
• Job Alerts - If you had previously registered to receive job alerts and wish to continue to receive these notifications, please re-register by clicking the "job alert" button.
• NEW! Didn't find a job that is right for you? Join a Talent Network to stay informed on news and job opportunities with the Anthem Team! It is important that you apply using an email address which is unique to you and not shared with a friend, relative, spouse, or significant other. Our recruiting system uses your email address as your unique identifier. If you apply with a shared email address, your application will overwrite any previous applicant record with the same email address. Additionally, please ensure that you use a valid email address, free from typos, as there are a variety of communications which may be sent to the email address with which you apply Process Expert I 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.
  The Process Expert I is responsible for the interpretation and data entry of moderately complex prescriptions, prior authorization processing, and troubleshooting adjudication issues.--
  Due to the current COVID-19 (coronavirus) pandemic, this position will require you to work remotely from your home with the flexibility to return to a regular, in-office work environment. As we continue to monitor guidance from CDC and state officials there may be times you would need to report to the office on a monthly or quarterly basis for team meetings or engagement activities.
  Responsibilities:
  • Enters and validates information on member prescriptions and reviews member prescriptions in claims system.
  • Educates provider on pharmacy based rules related to prescriptions and medication resources or assistance programs.
  • Processes prior authorization requests from physician's offices and ensures compliance with Medicare requirements.
  • Informs relevant parties of all prior authorization determinations.
  • Provides resolution to grievances and appeals issues.--
  • Responds to inquiries from physicians, sales team, and members related to formulary and prescription benefits.--
  • Generates reports relating to physician utilization--and other ad hoc reports.
  • Maintains record keeping of prior authorizations--and monthly reports.-- Qualifications Qualifications:--
    • HS Diploma or GED equivalent from an accredited Institution.
    • Requires an active, professional license such as Medical Assistant, LPN or Pharmacy Technician Certification.
    • 3 years related experience (business analysis, process improvement, project coordination), experience in high-volume managed care operations (claims, customer service, enrollment and billing); or any combination of education and experience, which would provide an equivalent background.
    • For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
    • Ability to work from home with internet access and a quiet and private workspace.
    • Ability to work the hours of 9:00 am - 5:30 pm EST with 1 required night shift per week from 10:30 am - 7:00pm EST and the ability to work overtime as needed. 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. Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem. EEO is the Law Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees. Anthem, Inc. is committed to helping individuals with disabilities participate in the workforce and ensuring equal opportunity to apply and compete for jobs. If you are an individual with a disability and require a reasonable accommodation to complete the application process, please email Human Resources at ability@icareerhelp.com for further assistance. *WARNING : Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Please be advised that Anthem will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission here by selecting the 'Rip-offs and Imposter Scams' option. Anthem requires a completed online application for consideration of employment for any position.

Keywords: Anthem, Inc., Miami , Process Expert I, Other , Miami, Florida