Provider Reimbursement Manager
About The Position
The Provider Reimbursement Manager manages key components of the provider reimbursement strategy. This is a hybrid role, with a preference for candidates in the Eastern or Central time zones who are within reasonable proximity to an eligible office. The role requires associates to be in-office 1-2 days per week to foster collaboration while maintaining flexibility for productivity and work-life balance. Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. As a Fortune 25 company with a longstanding history in the healthcare industry, we are looking for leaders passionate about making an impact.
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 or CIC certification
- WGS and/or GBD Facets experience
- Experience working post-pay reviews, validation, and recovery processes in the healthcare industry
- Experience managing multiple projects in various stages to completion
- Claim processing and adjustment experience
- Comfortable speaking to external stakeholders to present concepts, and be an SME on CoC.
Responsibilities
- Leads fee schedule development for specific plan(s) and/or the development and implementation of clinical editing rules.
- Works with the Health Service Area, actuarial, decision support, and underwriting to ensure that accurate cost of care targets are incorporated into product pricing and the company's financial plans.
- Performs and/or directs complex fee modeling exercises to ensure that projected unit reimbursement changes meet corporate cost targets.
- Provides analytical support for hospital and physician negotiations.
- Prepares and presents cost of care data analysis to support the regions cost of care initiatives.
- Develops and maintains the provider reimbursement strategy that will lower the cost of care, improve service, and reduce administrative expenses.
- Manages special projects and initiatives.
Benefits
- merit increases
- 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
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
