Director Enterprise Reimbursement Strategy

Elevance Health•Atlanta, GA

7d•Hybrid

About The Position

The Director Enterprise Reimbursement Strategy will be responsible for leading Cost of Care Ideation for Elevance Health contracts with a focus on services managed by Carelon Health, a subsidiary of Elevance Health. Will work cross-functionally with Ideation Leads for other services, aligned to clear and distinct operational archetypes, the associate will vet potential programs including accountability over proper modeling standards, operational assessments, and driving alignment to most appropriate execution entity within the global organization. This role will also take on the Ideation Profiling opportunities across all service types, including those managed directly by Elevance and/or Carelon Health.

Requirements

Requires a BA/BS degree in Business, Finance, Economics, or Healthcare Administration
A minimum of 10 years of related experience in broad-based, analytically oriented, managed care payor or provider environment required.
Experience must include project management, CMS payment methodology application, and financial/economic business modeling.

Nice To Haves

Advanced knowledge of managed care provider and claims payment systems and process is essential and strongly preferred.
CPA, MBA or other equivalent advanced degree is preferred.

Responsibilities

Development and implementation of strategic initiatives to control unit medical costs.
Evaluation of annual CMS reimbursement guidelines and recommendations as they relate to control over medical claims cost.
Research and develop new contracting and reimbursement methodologies.
Facilitates the communication of activities, emerging trends, and best practices with provider solution leadership across all lines of business.
Directs the daily interaction with and requests for reimbursement subject matter expertise and support.
Oversee and prioritize workflow.
Coordinates with Reimbursement Policy/Edit team as necessary to achieve strategic reimbursement related goals.
Works closely with CoC team on PADU (Preferred/Acceptable/Discouraged/Unacceptable).
Hires, trains, coaches, counsels, and evaluates the performance of direct reports.