Job Description

Provider Reimburse Admin

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 will be responsible for accurate translation of provider contracts, medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.

How you will make an impact:

• Ensures accurate adjudication of claims, by translating provider contracts, medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
• Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducts research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
• Translates provider contracts into reimbursement and operational support rules.
• Coordinates research and responds to system inquiries.
• Conducts research of audit systems and system edits to identify claims audit rule inventory for accuracy.
• Trains staff on system issues and rule creations.
• Works with provider contracting staff when new/modified reimbursement contracts are needed.

Minimum Requirements:

• Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Knowledge of provider networks, the medical management process, internal business processes, and expertise with internal local technology preferred.

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $62,568 - $93,852.

Locations: Illinois

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.

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

Job Family: PND > Pricing Configuration

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.

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