Anthem Medical Record Audit & Training Consultant - 130765SK in Walnut Creek, California

Your Talent. Our Vision.At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us andtogether 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.

Job Summary:

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:

  1. Conducts Risk Adjustment quality review audits for coding and documentation accuracy.

  2. Formulates recommendations and solutions based on audit trends and results.

  3. Reviews reports for coding issues and ensures correct dates of service being billed.

  4. Performs first pass diagnostic coding on EMR data feeds and review of OCR output for coding accuracy.

  5. Provides feedback to Risk & Recovery leadership on performance improvement opportunities.

  6. Acts as a coding and documentation subject matter expert to internal and external stakeholders in the area of federal requirements and best practices.

  7. Participates in and represents the department in business leadership groups, including external professional groups specializing in coding and provider education.

  8. Assists the business with research and documentation of workflows and policies and procedures.

    • Requires BA/BS in health sciences, health management, or any health care field.

    • 5 years of recent ICD-10/ICD-9 coding or medical record audit experience in a consultative role.

    • Any combination of education and experience, which would provide an equivalent background.

    • Coding certification to include either; CPC, CCS, CCS-P, RHIT, or other recognized coding certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute).

    • CRC is a plus.


/Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 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

Title: Medical Record Audit & Training Consultant - 130765SK

Location: CA-Walnut Creek

Requisition ID: 130765