Provider Reimburse Admin Sr

Provider Reimburse Admin Sr

This role requires associates to be in-office one day 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.

The Provider Reimburse Admin Sr ensures 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. Primary duties may include, but are not limited to:

• 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:

• 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.
• RN; Medical billing and coding certification strongly preferred.

Job Level: Non-Management Exempt

Workshift: Varies

Job Family: PND > Pricing Configuration

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.