Anthem Physical Therapist Reviewer -Richmond, Virginia - PS26532 in Jefferson City, Missouri
Physical Therapist Reviewer -Richmond, Virginia - PS26532
Location: United States
Requisition #: PS26532
Post Date: Aug 23, 2019
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.
Summary: The Physical Therapist Reviewer is responsible for performing medical record reviews specific to services billed related to physical therapy with adherence to all contract requirements, ISO processes and operational unit goals to ensure customer satisfaction.
Primary duties may include, but are not limited to:
Receives pre-authorization requests from front-line intake
Conducts initial medical necessity clinical review
Determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review
Conducts initial medical necessity review of out of network pre-authorization requests for services requested outside of the client health plan network
Notifies ordering physician or rendering service provider office of the pre-authorization determination decision
Documents the results of the initial clinical review and determination in the pre-certification computer system
Maintains confidentiality of patient and provider specific information
Develops telephone service standards to meet departmental performance metrics
Requires BA/BS in physical therapy:
3 years clinical experience; or any combination of education and experience, which would provide an equivalent background.
Physical Therapist with a current, valid unrestricted license in the state of VA
Graduate of a college level program in PT with up to 2 years recent clinical experience in an ambulatory or hospital setting preferred
Candidates should have good computer skills and solid typing speed and accuracy
Familiarity with managed health care programs including Medicaid
Familiarity with Utilization Management Guidelines preferred
Familiarity with ICD-10 preferred
Previous utilization and/or quality management and/or call center experience helpful
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc 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.