Anticipated End Date:
2026-08-15
Position Title:
Provider Reimbursement Manager
Job Description:
Provider Reimbursement Manager
LOCATION: Virtual eligible - Eastern or Central time zone highly preferred. You should be within a reasonable proximity to an eligible office.
HOURS: General business hours, Monday through Friday.
Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
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. Alternate locations may be considered if candidatesresidewithin a commuting distance from an office.
The Provider Reimbursement Manager manages key components of the provider reimbursement strategy.
Primary duties may include, but are not limited to:
Leads fee schedule development for specific plan(s) and/or the development and implementation of clinical editing rules.
Works with the Health Service Area, actuarial, decision support, and underwriting to ensure that accurate cost of care targets are incorporated into product pricing and the company's financial plans.
Performs and/or directs complex fee modeling exercises to ensure that projected unit reimbursement changes meet corporate cost targets.
Provides analytical support for hospital and physician negotiations.
Prepares and presents cost of care data analysis to support the regions cost of care initiatives.
Develops and maintains the provider reimbursement strategy that will lower the cost of care, improve service, and reduce administrative expenses.
Manages special projects and initiatives.
Required Qualifications
Preferred Qualifications
You must be CPC or CIC certified to be considered for this position.
WGS and/or GBD Facets experience preferred.
Experience working post-pay reviews, validation, and recovery processes in the healthcare industry strong preferred.
Experience managing multiple projects in various stages to completion strongly preferred.
Claim processing and adjustment experience strongly preferred.
You should be comfortable speaking to external stakeholders to present concepts, and be an SME on CoC.
Job Level:
Non-Management Exempt
Workshift:
1st Shift (United States of America)
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.
