Provider Reimbursement Policy Manager- Patient Safety

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 the posting location(s) will not be considered for employment, 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, 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.

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 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.

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, which would provide 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, which would provide 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 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.

*The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys sole discretion unless and until paid and may be modified at the Companys sole discretion, consistent with the law.