Provider Reimbursement Policy Manager- Patient Safety

Location: Indianapolis IN, Tampa FL, Atlanta GA, Columbus GA, Overland Park KS, Louisville KY, St. Louis MO, Richmond VA, Grand Prairie TX, Mason OH, Wilmington DE Hours: Standard Working hours Travel: This role requires associates to be in-office 1-2 days 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 if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from posting locations will not be considered unless an accommodation is granted as required by law. Position Overview The Provider Reimbursement Manager is responsible for managing key components of the provider reimbursement strategy and policy. Ensures accurate adjudication of claims, 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. How you will make an impact 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 region’s 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. Minimum 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 that provides an equivalent background. Preferred Skills, Capabilities and Experience CPC - Certified Professional Coder strongly preferred RN/Clinical background Preferred Patient Safety Experience preferred Understanding of pricing methodologies preferred including working with ICD-9/10CM, MS-DRG, AP-DRG and APR-DRG; or any combination of education and experience that provides an equivalent background. Strong research and analysis experience preferred Strong written and verbal communications For candidates working in person or virtually in the below location(s), the salary range for this specific position is $80,940 to $134,190 Locations: 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). The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. 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 View email address on click.appcast.io for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration ( #J-18808-Ljbffr Elevance Health