Carelon Medical Coding/Auditing Manager - Behavioral Health

Carelon Global Solutions Philippines, Inc.; Hanover (MD); On-site; USD 93,000 - 141,000; Full time

Job summary

A healthcare organization is seeking a Carelon Medical Coding/Auditing Manager for Behavioral Health, located in Hanover, MD. This full-time role involves ensuring the accuracy of claims payments, managing compliance with regulations, and providing leadership to a team. Ideal candidates will hold a BA/BS in a relevant field and have at least 5 years of experience, including medical coding and auditing. The company offers a competitive salary range and a comprehensive benefits package, emphasizing a hybrid work environment.

Benefits

Comprehensive benefits package

401(k) contribution

Equity stock purchase

Qualifications

• Minimum of 5 years related work experience, including 2 years leadership experience.
• Experience in medical coding/auditing preferred.
• Strong analytical skills and experience in health care.

Responsibilities

• Ensure accuracy of claims payment through management of billing processes.
• Monitor compliance program for fraud, waste, and abuse.
• Develop and analyze reports to support operational efficiency.

Skills

Claims payment accuracy

Fraud detection

Regulatory compliance

Education

BA/BS in business, engineering, nursing, finance, or healthcare administration

Tools

Excel

MS Word

Job description

Carelon Medical Coding/Auditing Manager - Behavioral Health page is loaded

Carelon Medical Coding/Auditing Manager - Behavioral Health

Apply locations MD-HANOVER, 7550 TEAGUE RD, STE 500 time type Full time posted on Posted 3 Days Ago time left to apply End Date: August 21, 2025 (26 days left to apply) job requisition id JR156186

Anticipated End Date:

2025-08-21

Position Title:

Carelon Medical Coding/Auditing Manager - Behavioral Health

Job Description:

Carelon Medical Coding/Auditing Manager - Behavioral Health

Supports Payment Integrity & Behavioral Health

Location: Must be located in Maryland. This role requires associates to be in-office 3-4 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.

• 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.

Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.

A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

The Medical Coding/Auditing Manager is responsible for ensuring the accuracy of claims payment through the management of a robust process for prevention, detection, and correction of billing, payment and membership errors. Works with health plan leaders, oversees the monitoring and enforcement of the fraud, waste, and abuse compliance program to prevent and detect potential fraud, waste, and abuse activities pursuant to state and federal rules and regulations.

How you will make an impact:

• Has detailed technical knowledge of claims payment accuracy and participates on cross functional teams focused on problem remediation and long term resolution.

• Anticipates the effect of changes in the business environment on future claim errors.

• Evaluates regulatory compliance and Health Care Reform changes to determine potential impact.

• Evaluates provider activities to assist in the detection of fraud, waste and abuse activities.

• Monitors provisions of the compliance plan, including fraud, waste, and abuse policies and procedures, investigates unusual incidents and implements corrective action plans.

• Develops and analyzes monthly reports.

• Develops project plans and oversees project execution, issue management and progress reporting.

• Develops processes to support early detection of systemic issues causing operational inefficiencies.

Minimum Requirements

• Requires a BA/BS in business, engineering, nursing, finance, or healthcare administration and minimum of 5 years related work experience, including minimum of 2 years leadership experience; or any combination of education and experience, which would provide and equivalent background.

Preferred Skills, Capabilities and Experiences

• MBA preferred.

• 5 years of medical coding/auditing experience preferred.

• Prior Behavioral Health auditing experience preferred.

• CPC is preferred.

• Proficiency with Excel/MS Word preferred.

For candidates working in person or virtually in the below location, the salary* range for this specific position is $ 93,828 to $140,742.

Locations:Maryland.

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

FRD > Compliance

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 [e-mail] 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.

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About Us

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.

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Who We Are

Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.Our nearly 100,000 associates serve approximately 100M+ people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.

Contract Opportunities at Elevance Health

Elevance Health is an Equal Opportunity Employer/Disability/Veterans.