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Posted: Tuesday, January 2, 2018 6:24 AM

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 Outreach Specialist * (Medical Investigations Analyst) * Location: * Any Anthem Office Location The*Medical Outreach Specialist* is responsible for supporting the retrieval of medical records from providers and hospital facilities to support Commercial Risk Adjustment. You will be required to resolve issues in retrieval of medical records from large facilities and responsible for setting up more streamlined and automated electronic medical record retrieval. Responsible for performing the necessary claims research and medical record review to determine accurate diagnosis code submissions, compile medical, billing and claims information resulting in risk adjustments, provider incentives, and the resolution of claims and billing discrepancies. This is a highly administrative position within the Commercial Risk Adjustment Programs area of the CSBD (Commercial and Specialty Division). Requires excellent communications skills and be comfortable speaking on the telephone with provider offices at least 50% of the day. Primary duties may include, but are not limited to: * Generates letters to members to request information and relay review determinations. * Requests medical records from providers and contacts members/providers via telephone for basic information needed for review. * Researches and resolves claims and billing discrepancies. * Identifies errors in ICD-10 coding. * Presents information to providers regarding the benefits of giving access to their Electronic Medical Records (EMR) and assists in the coordination and implementation of access. * Creates reports for finance on Provider/Broker incentive payments. * Reviews medical records for risk adjustment opportunities. * Organizes documentation when referral to underwriting is necessary, applying appropriate underwriting and/or benefit administration guidelines. * Maintains records of cases in progress and results of underwriting review. * Facilitates adjustment of claims. * Requires an AS/BS in Life Sciences or any related health care field; a minimum of 1 year of experience in the healthcare field (ie nursing, EMT, billing or claims office, hospital, clinic, medical office, insurance company, etc.); or any combination of education and experience, which would provide and equivalent background. * Must have experience with medical record retrieval and review. * Excellent verbal communication skills and a professional demeanor, with the ability to talk on the phone to physician offices for extended periods of time. Preferred * Claims research and review experience preferred. * Knowledge of ICD10 codes a plus. * Must be self-directed, organized, with attention to detail. * Computer/technical skills: MS office (Word, Outlook, Excel), Sharepoint, RightFax, computer based billing and claims systems. * Recent/*Anthem*/experience with provider and/or member outreach and engagement a plus. */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./* **Job** *Medical*Equal Employment Opportunity StatementAnthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity. **Title:** *Medical Outreach Specialist (Risk Adjustment Unit) - Any Anthem Office - 138589* **Location:** *georgia-Macon* **Requisition ID:** *138589* Company Description:We recently changed our name from WellPoint to Anthem, Inc., the name people know us by best. As our companies continue to take a more active role in helping people access the right health care and programs, going by a name that people know and trust is important.Anthem, Inc. is one of the nation's leading health benefits insurer and a Fortune Top 50 company. At Anthem, Inc., we are working to transform health care with trusted and caring solutions and meaningfully advance affordability and better health outcomes for our health plan members. Nearly 69 million people are served by our affiliated companies including more than 37 million enrolled in our family of health plans. One in nine Americans receives coverage for their medical care through Anthem's affiliated plans.We offer a broad range of medical and specialty products.Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to help drive the future of health care.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 co


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