Anthem, Inc. Digital Product Director (Clinical) in Tampa, Florida
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: This position may be located within 50 miles of one of our major office locations in GA, IL, or IN.
Job Title: Digital Product Director
The Digital Products Director is a part of the dynamic Anthem Enterprise Data Science team, and will be focused on converting advanced insights into next-generation payment, coding, and clinical edits. He/she works with business and technology stakeholders to build end to end processes from overall business perspective and strategic objectives.
Produce high quality solutions that are robust, reliable, and scalable
Research and develop novel solutions independently and as part of a team.
Provide technical vision and leadership.
Responsible for development and delivery of the business unit software solutions technology road map to ensures specific technology solutions are in place to support business and it customers.
Work with leadership to design and deliver technology requirements and leverages necessary resources.
Assesses the compatibility and integration of products/services proposed as standards in order to ensure an integrated architecture across interdependent technologies.
Create detailed testing protocols for ensuring updates to software and edits delivered in accordance with requirements
Champions and responsible for concept development under agreed-upon timelines.
Interpret and deliver business requirements for required software updates to ensure compliance with policy, contracting, regulatory changes or updates.
Performs technical planning, architecture development and modification of specifications.
Develops specifications for products/services, applications and service offerings.
Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 8 years of experience in architecture/design in relevant technology disciplines; or any combination of education and experience, which would provide an equivalent background.
Experience in health care industry strongly preferred.
Ability to read and analyze payer medical and payment policy, as well as provider contracts, translating into software edits, to ensure accurate claims payment
Ability to read and analyze Medicare/Medicaid data and policy, bulletins, manual updates, fee schedules, translating into software edits, to ensure accurate claims payment.
Ability to communicate effectively and collaborate with diverse internal and external stakeholder groups and individuals.
Recommends new solutions to ensure claim payment accuracy and integrity; this could be automated or manual.
Understanding of payment integrity functions, healthcare data, data requirements, data constraints, business process and workflows, automation, and service delivery and benefit structure to align end to end processes.
Ability to deliver and drive new content based upon roadmaps defined by enterprise data roadmaps.
Cross-functional knowledge (e.g., strategy, change management, business process management).
Knowledge of standard payment policy, medical policy, and payer and government regulations
Understanding of NCCI, MUE, Medicare PFS edits
Able to collect, research, and understand diverse information sets, and translate into clear and concise requirements
FACETS and/or WGS experience a plus.
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. 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 email@example.com for assistance.