Anthem, Inc. Mandate Plan/Evaluation Director in Alexandria, Virginia
SHIFT: Day Job
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.
Location: Work-At-Home Opportunity - Nationwide
The Mandate Plan/Evaluation Director is responsible for serving as a subject matter expert and providing enterprise-wide planning, intake, analysus, and business requirement development for the Affordable Care Act (ACA) Preventive Care mandate. Primary duties may include, but are not limited to:
Act as the single point of contact for ACA Preventive Care.
Develop, implement and maintain competitive and Federally compliant ACA Preventive Care benefit across Anthem’s ACA compliant Commercial book of business– all 14 states and all market segments (IND, SG, LG, and ANA).
As new guidelines/recommendations are released:
Partner with medical directors and coding team to identify appropriate codes and update Anthem’s Enterprise ACA Preventive Care list accordingly.
Identify implementation options and make recommendations to leadership on the best approach. The recommendation should ensure limited member abrasion and keep the cost of care. Design and articulate compliance strategy to effectively manage the cost of care.
As new codes are released by AMA and CMS or codes are deleted/changed, determine impacts to Anthem’s Enterprise ACA Preventive Care list.
Partner with Pharmacy team to update ACA Preventive Care drugs, as needed, keep in mind age restrictions.
Partner with AIM and Medical Policy to identify impacts to support ACA Preventive Care compliance.
Support internal and external questions about how Anthem implements ACA Preventive Care; this could be from sales teams on behalf of ANA clients, or from the appeals team on behalf of a member, or to support an audit or state mandate, or from the digital team trying to understand how to communicate to members on anthem.com/Sydney.
Monitor spending associated with ACA Preventive Care; run claim reports to better understand how claims are processed for certain services, encourage the development of a full report to understand total annual spend on ACA Preventive across FI and ACA book, pharmacy, and medical.
Facilitate ACA Preventive Care team meetings to ensure timely updates are made to the medical coding list referred to as the Enterprise ACA Preventive Care list.
Analyze RE and RA monthly reporting to ensure groups appropriately fell off report due to term or have been added correctly.
Analyze and recommend opportunities to reduce the cost of care associated with ACA Preventive Care. For example, explore enhancing claims logic to restrict claim payments at 100% or implement age restrictions of ACA Preventive Care services.
Minimum Requirement: Requires a BA/BS degree and a minimum of 10 years of related experience including 2 years of regularity/compliance oversight; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications: Prior leadership of complex initiatives involving a matrix-managed team and experience in the area of mandate interpretation/analysis strongly preferred. MBA preferred. Ability to travel may be required. Must be able to perform all duties of lower-level positions as directed by management.
Applicable to Colorado Applicants Only
Annual Salary Range*: $112,896 - $141,120
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
The hourly or salary range is the range Anthem in good faith believes is the range of possible compensation for this role at the time of this posting. The Company may ultimately pay more or less than the posted range. This range is only applicable for jobs to be performed in Colorado. This range may be modified in the future. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
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. The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.