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Coding (Provider) Reimburse Admin Senior

Location:

  • VA, Norfolk
  • North Carolina, North Carolina
  • Indiana, Indiana
  • South Carolina, South Carolina
  • Florida, Florida
  • Georgia, Georgia
  • New Hampshire, New Hampshire
  • Kansas, Kansas

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Description

Title: Coding (Provider) Reimburse Admin Senior 

Location: Fully Remote

Working Hours: 7AM – 9AM Flexible 

How you will make an impact:

  • Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.

  • Serves as subject matter expert regarding reimbursement policies, edits, and coding conventions.

  • Primary duties may include, but are not limited to: Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring policies and edits do not conflict with Federal and state mandates.

  • Works with other departments on claims adjudication workflow development and business process improvements.

  • May lead the full range of provider reimbursement activities for a state(s).

  • Leads projects related to provider reimbursement initiatives.

  • Serves as a mentor to less experienced administrators.

  • Independently interprets Medical and Reimbursement Policies and Clinical Guidelines.

  • Completes and maintains detailed documentation of edit change requests.

  • Ensures deadlines are met along with ensuring the quality of work.

  • Contacts others to obtain any necessary information.

  • Identifies claims processing edit errors and initiates claim adjustment projects.

Minimum Requirements:

  • Requires a BA/BS degree and a minimum of 4 years related experience; or any combination of education and experience, which would provide an equivalent background.

  • RN; Medical billing.

Preferred Skills, Capabilities and Experiences:

  • CPC (Certified Professional Coder) highly preferred.  

  • Facets and/or WGS experience preferred.

  • Proficiency with Microsoft Word, Excel and SharePoint preferred.


Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 ability@icareerhelp.com for assistance.

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