Provider Reimburse Admin Sr

Elevance Health•Las Vegas, NV

3d•Hybrid

About The Position

Provider Reimburse Admin Sr Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Provider Reimburse Admin Sr will be responsible for ensuring accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Serves as subject matter expert regarding reimbursement policies, edits, and coding convention. How you will make an impact: Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring policies and edits do not conflict with Federal and state mandates. Works with other departments on claims adjudication workflow development and business process improvements. May lead the full range of provider reimbursement activities for a state(s). Leads projects related to provider reimbursement initiatives. Serves as a mentor to less experienced administrators. Minimum Requirements: Requires a BA/BS degree and a minimum of 4 years related experience; or any combination of education and experience, which would provide an equivalent background. Preferred Skills, Capabilities and Experiences: WGS experience preferred. Claims processing experience preferred. Pricing Configuration experience preferred. Experience writing Business/Technical Requirements preferred. Strong research, oral and written communication skills preferred. For candidates working in person or virtual in the below location(s), the salary range for this specific position is $74,340- $122,130 Locations: California, Colorado, Nevada & 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.

Requirements

Requires a BA/BS degree and a minimum of 4 years related experience; or any combination of education and experience, which would provide an equivalent background

Nice To Haves

WGS experience preferred
Claims processing experience preferred
Pricing Configuration experience preferred
Experience writing Business/Technical Requirements preferred
Strong research, oral and written communication skills preferred

Responsibilities

ensuring accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria
Serves as subject matter expert regarding reimbursement policies, edits, and coding convention
Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring policies and edits do not conflict with Federal and state mandates
Works with other departments on claims adjudication workflow development and business process improvements
May lead the full range of provider reimbursement activities for a state(s)
Leads projects related to provider reimbursement initiatives
Serves as a mentor to less experienced administrators