Provider Reimbursement Manager- Patient Safety

Elevance Health•Tampa, FL

4d•$80,940 - $134,190•Hybrid

About The Position

The Provider Reimbursement Manager is responsible for managing key components of the provider reimbursement strategy and policy. Ensures accurate adjudication of claims, by translating various complex coding, business and billing rules and standards into effective and accurate reimbursement policies. Serves as subject matter expert regarding reimbursement policies, edits, behavioral health standards, billing, and coding conventions.

Requirements

Requires a BA/BS degree in a related field and a minimum of 7 years reimbursement experience including performing detailed financial modeling and economic analyses; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

CPC -Certified Professional Coder strongly preferred
RN/Clinical background Preferred
Patient Safety Experience preferred
Understanding of pricing methodologies preferred including working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience, which would provide an equivalent background.
Strong research and analysis experience preferred
Strong written and verbal communications

Responsibilities

Leads policy development for specific plan(s) and/or the development and implementation of behavioral health reimbursement policy rules.
Works with the multiple business areas to ensure that accurate cost of care targets are incorporated into the company's financial plans.
Performs and/or directs complex research to ensure that projected changes meet corporate cost targets.
Prepares and presents cost of care data analysis to support the regions cost of care initiatives.
Develops and maintains the provider reimbursement policies that will lower the cost of care, improve service, and reduce administrative expenses.
Manages special projects and initiatives.