Anticipated End Date:2026-06-24
Position Title:Provider Reimbursement Manager- Behavior Health -Coding
Job Description:Location: 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. EST/CST hours only.
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.
This position is not eligible for employment based sponsorship.
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
- 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
Job Level:Non-Management Exempt
Workshift:Job Family:PND > Pricing Configuration
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
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