Provider Reimburse Admin 4 Locations

Anticipated End Date:

Position Title:

Job Description:

Location:  Norfolk VA, Tampa FL, Indianapolis IN, Atlanta GA

Hours: Monday - Friday

Travel: Hybrid (1-2 days per week onsite)

Position Overview:

Ensures accurate adjudication of claims, by translating medical policies, reimbursement criteria, and clinical editing rules, and correct coding guidelines into effective and accurate reimbursement policies.

How You Will Make an Impact:

• Reviews company specific, CMS specific, competitor specific policies, and editing rules, as well as conducts research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy

• Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for policy, reimbursement development, and implications for system edits

• Coordinates research and responds to system inquiries and appeals

• Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy

• Performs pre-adjudication claims reviews to ensure proper coding was used

• Prepares correspondence to providers regarding coding and fee schedule updates

• Trains customer service staff on system issues

• Works with provider contracting staff when new/modified reimbursement contracts are needed

Required Qualifications:

• Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications:

• CPC and CPC-A license is a must

• Claims experience is strongly preferred

• Experience communicating with various levels of an organization

• Proficiency in Microsoft Word, Excel and SharePoint.

• Strong research skills and perform well independently and in a team setting

• Knowledgeable of the application of Medicaid, Medicare or Commercial reimbursement policies and guidelines

• FACETS or WGS experience preferred

• NCCI, MUE, of modifier experience preferred

• Strong Written and verbal communication skills preferred

Job Level:

Workshift:

Job Family:

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.