Provider Reimbursement Administrator Senior

Elevance Health•Norfolk, VA

3d•Hybrid

About The Position

Provider Reimbursement Administrator Senior Hybrid 1: 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 Reimbursement Administrator Senior is responsible to ensure 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 conventions. 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.

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

RN
Medical billing and coding certification strongly preferred
Medical billing and coding certification AAPC/AHIMA strongly preferred
Claim edit experience strongly preferred
WGS and/or GBD Facets experience preferred

Responsibilities

ensure 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 conventions
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