Provider Reimbursement Admin (Evaluation and Management Coding/Auditing) 37 Locations

Location: This position will work a hybrid model (remote and office) which requires working in the nearest Elevance Health office 1-2 times per week.  The rest of the time would be working remotely (from home).  Must live within 50 miles of one of our Elevance Health office locations. 

The  Provider Reimbursement Admin (Evaluation and Management Coding/Auditing) ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.

How You Will Make an Impact

Primary duties may include, but are not limited to:

• Reviews company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules, as well as conducts clinical 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 coverage, 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.

Minimum Requirements:

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. American Academy of Professional Coders (AAPC) CPC, CEMC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P coding certification is required.

Preferred Skills, Capabilities and Experiences:

• Proficiency in Microsoft Word, Excel and SharePoint.

• EM Leveling audit experience preferred.

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

• Experience working in a production environment with short timelines is strongly preferred.

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

• FACETS or WGS experience preferred.

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $57,456 - $98,496

Locations:  California; Colorado, Illinois, Maryland, Minnesota, Nevada; New York; Washington State

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.  The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. 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.