Implement & Coding Consultant

Elevance Health • Atlanta, GA

8d • Hybrid

About The Position

The Implement & Coding Consultant leads the development, implementation, and evaluation of Corporate Medical Policy coding strategies across the enterprise. The role develops implementation approaches that account for enterprise and regional business objectives, adjudication systems, benefit design, and regulatory environments. It evaluates business and technical factors to recommend coding and implementation options, and works with clinical and operations stakeholders to balance clinical, coding, systems, cost, and provider-relations considerations.

The consultant supports medical policy and clinical utilization management guideline development and review by creating and maintaining coding sections, provides support to the Medical Policy Research team, and develops quality assurance processes for accurate code assignment and translation into adjudication systems. The position also compiles and communicates coding updates, analyzes codes and answers internal coding inquiries, coordinates Coding & Implementation meetings, and supports the department's document management system. It leads work groups, resolves local implementation issues, and improves processes, tools, and measures to standardize performance and demonstrate value to business units.

This is a hybrid role requiring in-office work 1–2 days per week. The schedule is Monday through Friday, 8:00 a.m.–5:00 p.m. Eastern, with additional hours potentially needed based on company needs. Candidates must live within a reasonable commuting distance of an office unless an accommodation is granted as required by law. The position is non-management and exempt.

Requirements

• Bachelor's degree (BA/BS) and at least 5 years of related medical policy experience, including prior experience leading large, multi-stakeholder regional or enterprise projects; or an equivalent combination of education and experience.
• Ability to work in a hybrid arrangement with in-office attendance 1–2 days per week and reside within reasonable commuting distance of an office, unless an accommodation is granted.
• Availability to work Monday through Friday, 8:00 a.m.–5:00 p.m. Eastern, with additional hours potentially required based on company needs.

Nice To Haves

• Certified Professional Coder (CPC) certification is strongly preferred.
• Experience reviewing clinical criteria and assigning codes according to coding guidance is highly preferred.

Responsibilities

• Develop and evaluate enterprise Corporate Medical Policy coding and implementation strategies.
• Design implementation approaches that account for regional business objectives, adjudication systems, benefit design, and regulatory environments.
• Assess business and technical factors, evaluate implementation and coding options, and recommend an optimal approach for specific policies.
• Optimize policy implementation solutions by balancing clinical, coding, systems, cost, and provider-relations considerations.
• Communicate and monitor policy implementation in collaboration with clinical and operations stakeholders in business units.
• Create and maintain coding sections in medical policy and clinical UM guideline documents, supporting their development and review.
• Support the Medical Policy Research team.
• Develop quality assurance processes to ensure accurate code assignment on policies and translation within adjudication systems.
• Compile and classify quarterly coding updates from CMS and the AMA, and communicate updates related to MPTAC decisions.
• Perform coding analysis and respond to coding inquiries from internal business partners, including providing coverage for a shared mailbox.
• Manage materials for weekly Coding & Implementation meetings and facilitate meetings as needed.
• Assist with maintaining the department Document Management System, including code entry, quality assurance processes, and report releases.
• Improve processes, tools, and measures to standardize implementation performance and demonstrate quantifiable value to business units.
• Lead the work group and facilitate identification and resolution of local implementation issues.
• Complete other duties as assigned.

Benefits

• Comprehensive benefits package, subject to eligibility requirements.
• Incentive and recognition programs.
• Equity stock purchase plan.
• 401(k) contribution and matching.
• Merit increases.
• Paid holidays.
• Paid time off.
• Incentive bonus programs, unless covered by a collective bargaining agreement.
• Medical insurance.
• Dental insurance.
• Vision insurance.
• Short- and long-term disability benefits.
• Life insurance.
• Wellness programs.
• Financial education resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level