Location: Columbus OH, Seven Hills OH, Mason OH, Cincinnati OH

Hours: M – F Standard Working hours

Travel: This role requires associates to be in-office 1 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.

Position Overview:

LTSS Claims Educator facilitates the exchange of information between the grievances, claims processing, and provider relations systems. This position works closely with the Network Education Rep to develop training content specific to LTSS provider claims, to be incorporated into LTSS provider onboarding and continuing education.  As well as tracking and trending LTSS claims data, providing technical assistance and ad-hoc training to LTSS providers both virtually and in-person. 

How You Will Make an Impact:

• Educating contracted and noncontracted providers (professional and institutional) regarding appropriate claims submission requirements, coding updates, electronic claims transactions, and electronic fund transfer 

• Educating contracted and non-contracted providers on available Contractor resources such as provider manuals, website, fee schedules, etc 

• Identifying trends and guiding the development and implementation of strategies to improve provider satisfaction; and frequently communicating with providers, including conducting on-site visits, to assure the effective exchange of information and gain feedback regarding the extent to which providers are informed about appropriate claims submission practices 

• Provides/coordinates provider training for claims and billing procedures and contract compliance 

• Supports the contractual agreements with all providers to ensure compliance with local/state/federal regulations 

• Provides leadership in the development, implementation and evaluation of provider operations, contracting and issue resolution strategies 

• Reviews state and national programs, trends and literature regarding provider issues and recommend appropriate strategies 

Required Qualifications:

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

Preferred Qualifications:

• Experience with Healthcare (Claims) is a must

• Prior experience as an LTSS or HCBS provider or in a provider office is preferred 

• Intermediate Excel experience strongly preferred 

• SQL experience preferred 

• Experience training or mentoring 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.

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 and Influenza. 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.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.