Anthem Inc. Virginia Jobs

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Anthem, Inc. Medicare Medical Records Audit & Training Consultant in Norfolk, Virginia


SHIFT: Day Job

SCHEDULE: Full-time

At Empire BlueCross BlueShield, a proud member of the Anthem, Inc. family of companies, serving our communities for over 85 years. 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.

Empire’s commitment to inclusion and diversity makes us a stronger organization. Our culture is essential to attracting talent that understands and connects with our consumers. It creates spaces where different perspectives and experiences are valued; it lets us develop innovative thinking and unifies our associates behind our mission—to materially and measurably improve the whole health of all New Yorkers and make healthcare simpler.

Empire’s Whole Health proposition is committed to protecting an individual’s complete health and wellness. Our inclusivity is the foundation to serve and support our diverse New York communities.

Medicare Medical Records Audit & Training Consultant

Preferred Location: New York Metropolitan Area

Will consider other locations within the Eastern Time Zone for the most qualified applicants

The Medical Records Audit & Training Consultant is 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:

  • Serves as an auditor on the Risk & Recovery’s Retrospective Risk Adjustment (RA) Coding Team.

  • Identifies training opportunities for internal and external stakeholders related to federal guidelines, best practices, and medical record documentation requirements.

  • Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.

  • Provides feedback risk adjustment educational opportunities as a result of performance gaps.

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

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

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


Required Qualifications:

  • Requires BA/BS in health sciences, health management, or nursing; 5 years of ICD-10 coding or medical record audit experience in a consultative role; or any combination of education and experience, which would provide an equivalent background.

  • CPC from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) and CPMA (Medical Auditing Certification) from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) or equivalent certification required.

    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. 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 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.

    REQNUMBER: PS55078-Norfolk-Norfolk