Provider Reimbursement Manager

Elevance Health • Indianapolis, IN

23h • $80,940 - $153,360 • Hybrid

About The Position

Manages key components of the provider reimbursement strategy. Serves as the primary point of contact for assigned Medicaid markets, building strong, working relationships with market leaders and operational teams to drive alignment on prepay editing strategy.

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, RHIT, or RHIA certifications preferred
• Deep, working knowledge of prepay editing within Elevance, including existing edit logic, workflows, and systems
• Strong understanding of correct coding initiatives (CCI), reimbursement policy, and claims editing best practices
• Direct experience interpreting and operationalizing state Medicaid guidelines, including translating regulatory language into actionable business rules
• Proven experience onboarding new Medicaid markets, including assessing state-specific requirements and implementing compliant prepay edit strategies
• Experience maintaining ongoing market-level compliance through continuous monitoring, gap identification, and remediation
• Ability to influence without authority and drive alignment across market leadership, operations, and enterprise teams
• Strong analytical and problem-solving skills, with the ability to connect regulatory requirements to financial and operational outcomes

Responsibilities

• Lead ongoing collaboration with markets to ensure prepay edit compliance with evolving state Medicaid guidelines, translating regulatory changes into actionable edit requirements
• Identify and drive opportunities to improve cost of care performance, including socializing new edit concepts, quantifying impact, and partnering with markets to remediate risk and implement changes
• Support onboarding of new Medicaid markets by conducting deep reviews of state-specific reimbursement rules, billing guidelines, and regulatory requirements, and translating them into prepay edit logic
• Maintain and continuously enhance a centralized repository of state-specific edit requirements, ensuring accuracy, traceability, and accessibility for stakeholders
• Act as a subject matter expert on prepay editing, reimbursement policy, and correct coding, providing guidance to internal partners and influencing decision-making
• Partner cross-functionally with clinical, coding, analytics, and technology teams to ensure edits are operationalized effectively and delivering expected outcomes
• Monitor performance and compliance across assigned markets, proactively identifying gaps and driving corrective action

Benefits

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources

What This Job Offers

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