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Provider Reimburse Manager

Location:

  • MA, BOSTON

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Description

Provider Reimburse Manager

*This is an Individual Contributor Role.


Location: This position will work a Hybrid Model (remote and 1 day a week in the office).   Candidates must live within 50 miles of an Elevance Health corporate office location.


Work Shift: Monday thru Friday, 8:00 am to 5:00 pm. 


The Provider Reimburse Manager manages key components of the provider reimbursement strategy. 


How will you make an impact: 

  • 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. 

  • Develops standard and supports team training, UAT guidelines, and customer driven artifacts. 

  • Manages workforce request items and daily tasks.


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 Experiences:

  • CPA, MGA MBA or other equivalent advanced degree strongly preferred.

  • Experience with SQL, DB Visual Basics, Visio and project management preferred.


 

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.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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. 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 elevancehealthjobssupport@elevancehealth.comfor assistance.

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