Hybrid Implement & Coding Consultant — Policy Lead

Elevance Health; Mason (OH); Hybride; USD 79 000 - 136 000; Plein temps

Avantages offerts par ce poste

Hybrid work arrangement

Résumé du poste

Elevance Health is seeking an Implement & Coding Consultant to lead the development, implementation, and evaluation of coding strategies across the enterprise. The role requires balancing clinical, coding, and systems factors while coordinating with clinical and operations teams.

The position emphasizes collaboration, policy translation, and QA of code assignment within adjudication systems, with strong CPC preference and a BA/BS plus 5 years of policy experience.

Qualifications

• Requires a BA/BS degree and a minimum of 5 years of related medical policy experience including leading large, multi-stakeholder projects.
• Certified Professional Coder (CPC) strongly preferred.
• Experience reviewing clinical criteria and assigning codes according to coding guidance.

Responsabilités

• Conceptualizes implementation approaches that consider broad business issues across regions and details of adjudication systems, benefit design, and regulatory environments.
• Assesses multiple business and technical factors to identify and evaluate implementation and coding options for specific policies and recommends the optimal approach.
• Optimizes enterprise solutions for policy implementation balancing clinical, coding, systems, cost, and provider relations elements.
• Communicates and monitors execution of a value-added approach to policy implementation with clinical and operations stakeholders.
• Supports the enterprise medical policy and clinical UM guideline development/review process through coding sections in documents.
• Provides coding analysis and responds to coding inquiries for internal business partners.

Connaissances

CPC

Medical coding

Policy interpretation

Formation

BA/BS degree

Description du poste

Elevance Health is seeking an Implement & Coding Consultant to lead the development, implementation, and evaluation of coding strategies across the enterprise. The role requires balancing clinical, coding, and systems factors while coordinating with clinical and operations teams.

The position emphasizes collaboration, policy translation, and QA of code assignment within adjudication systems, with strong CPC preference and a BA/BS plus 5 years of policy experience.