Provider Reimbursement Manager- Behavior Health -Coding

About the role

The Provider Reimbursement Manager is responsible for managing key components of the provider reimbursement strategy and policy. Ensures accurate adjudication of claims, by translating various complex coding, business and billing rules and standards into effective and accurate reimbursement policies. Serves as subject matter expert regarding reimbursement policies, edits, behavioral health standards, billing, and coding conventions.

Responsibilities

• Leads policy development for specific plan(s) and/or the development and implementation of behavioral health reimbursement policy rules.
• Works with the multiple business areas to ensure that accurate cost of care targets are incorporated into the company's financial plans.
• Performs and/or directs complex research to ensure that projected changes meet corporate cost targets.
• Prepares and presents cost of care data analysis to support the regions cost of care initiatives.
• Develops and maintains the provider reimbursement policies that will lower the cost of care, improve service, and reduce administrative expenses.
• Manages special projects and initiatives.

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.

Preferred Skills, Capabilities and Experience

• CPC - Certified Professional Coder strongly preferred
• MBA or other equivalent advanced degree strongly preferred.
• Strong behavioral health background preferred.
• Strong critical thinking and analytical skills.
• Understanding of pricing methodologies preferred.
• Strong written and verbal communications.

Benefits

Location: Virginia
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Pay

The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

Schedule

Location: Virginia
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.