Provider Reimbursement Manager

🔥 0 minutes ago

🏈 Ohio, Missouri, +1 more states – Remote

🏈 Ohio – Remote 🏰 Missouri – Remote 🎸 Tennessee – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

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Elevance Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Elevance Health is transforming from a traditional health benefits organization into a lifetime trusted health partner, driven by a bold purpose to improve the health of humanity. With nearly 100,000 associates, they serve over 118 million people and utilize an integrated whole health approach supported by industry-leading capabilities and a digital health platform. Their mission includes redefining health, reimagining the health system, and strengthening communities.

📋 Description

• Lead fee schedule development for specific plans and/or develop and implement clinical editing rules • Work with Health Service Area, actuarial, decision support, and underwriting teams to incorporate accurate cost-of-care targets into product pricing and financial plans • Perform and/or direct complex fee modeling exercises to ensure projected unit reimbursement changes meet corporate cost targets • Provide analytical support for hospital and physician negotiations • Prepare and present cost-of-care data analysis supporting regional cost-of-care initiatives • Develop and maintain provider reimbursement strategies to lower cost of care, improve service, and reduce administrative expenses • Manage special projects and initiatives • Present concepts to external stakeholders and serve as a subject matter expert on cost of care

🎯 Requirements

• BA/BS degree in a related field and a minimum of 7 years of reimbursement experience, including detailed financial modeling and economic analyses; or an equivalent combination of education and experience • CPC or CIC certification required for consideration • WGS and/or GBD Facets experience preferred • Experience with post-pay reviews, validation, and recovery processes in the healthcare industry strongly preferred • Experience managing multiple projects through completion strongly preferred • Claim processing and adjustment experience strongly preferred • Comfortable presenting concepts to external stakeholders • Subject matter expertise in cost of care • Ability to work general business hours, Monday through Friday • Candidates must reside within reasonable commuting distance of an eligible office unless an accommodation is granted • Eastern or Central time zone highly preferred

🏖️ Benefits

• Merit increases • Paid holidays • Paid Time Off • Incentive bonus programs • Medical benefits • Dental benefits • Vision benefits • Short-term disability benefits • Long-term disability benefits • 401(k) with company match • Stock purchase plan • Life insurance • Wellness programs • Financial education resources • Flexible virtual work arrangement • Required in-person training sessions supporting onboarding and skill development