Provider Reimbursement Manager

Location: Virtual eligible – Eastern or Central time zone highly preferred. You should be within a reasonable proximity to an eligible office.

Schedule: General business hours, Monday through Friday. This role enables associates to work virtually full-time, with the exception of required in-person training sessions.

About the role

The Provider Reimbursement Manager manages key components of the provider reimbursement strategy.

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.

Requirements

• 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.

Preferred Qualifications

• 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.

Benefits

• Merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement).
• Medical, dental, vision, short and long term disability benefits.
• 401(k) + match, stock purchase plan, life insurance.
• Wellness programs and financial education resources.

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.