Senior Payment Integrity Data Consultant

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. 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. 

The Senior Payment Integrity Data Consultant (Business Information Developer Consultant Senior) is viewed as an expert in the development and execution of data mining analyses.  This position is focused on spending time thinking about programming and how it would be used to design solutions.  

How You Will Make an Impact:  

• Undertakes complex assignments requiring additional specialized technical knowledge.  
• Develops very complex and varied strategic report applications from a Data Warehouse.  
• Establishes and communicates common goals and direction for the team.  
• Establishes and maintains advanced knowledge of data warehouse database design, data definitions, system capabilities, and data integrity issues.  
• Acts as a source of direction, training and guidance for less experienced staff.  
• Monitors project schedules and costs for own and other projects.  
• Develops and supports very complex Data Warehouse-related applications for business areas requiring design and implementation of database tables.  
• Conducts training on the use of applications developed.  

Minimum Requirements: 

• Requires a BS/BA degree; minimum of 6 years experience; or any combination of education and experience, which would provide an equivalent background.  

Preferred Skills, Capabilities, and Experiences: 

• Expert level PC, spreadsheet, and database skills, as well as experience in standard Business Information tools and programming/query languages.  
• The ability to communicate effectively with multiple levels within the organization is strongly preferred. 
• 5+ years of claims editing experience with healthcare payers and/or claims editing software vendors, strongly preferred. 
• Billing, coding, revenue cycle, and claims editing software experience, required. 
• Nationally recognized coding or billing credential preferred: CCS, CCS-P, CPC, CPB, CIC. 
• Experience in claims adjudication and application of NCCI editing and claims payment rules. 
• Ability to interpret claim edit rules and references. 
• Ability to apply industry coding guidelines to claim processes. 
• Proven experience reviewing, analyzing, and researching coding issues for payment integrity. 
• Logic skills: ability to break policy edits down into decision making paths. 
• Ability to troubleshoot and apply root-cause analysis of logics not functioning as intended. 
• Strong ideation skills. 

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.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.