Hybrid Program Manager - Ohio Medicaid Claims

The Elevance Health Companies, Inc.; North Carolina; Hybrid; USD 93,000 - 139,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

Elevance Health in Columbus, OH is seeking a Program Manager for Ohio Claims to lead Medicaid claims configuration, rate changes, compliance and contractual updates. The role coordinates with claims, provider experience, utilization management, regulatory teams, and call center leads to resolve policy and reimbursement issues.

The position requires a BA/BS and at least 5 years of external client facing program management experience.

Qualifications

• Requires BA/BS and minimum of 5 years external client facing experience in program/project management.
• Graduate degree and/or PM certification preferred.
• Strong understanding of Dual (Medicare and Medicaid) claims configuration & adjudication preferred.

Responsibilities

• Collaborate with claims, provider experience, utilization management, regulatory and call center leads to resolve policy and reimbursement issues.
• Ensure on-time delivery of regulatory reports related to claims (e.g., Prompt Pay, Claims Disputes).
• Manage development, approval, implementation and compliance of ongoing external client facing programs.
• Research industry practices and stay aware of trends in claims.
• Manage external client relationships and partner with corporate and regional areas.
• Develop program success measures and perform periodic assessments.
• Oversee end-to-end claims process including receipt, adjudication, payment, and performance reporting.
• Serve as operational liaison with the state of Ohio, Provider Experience, and internal leadership.

Skills

Program management

Client facing

Regulatory reporting

Education

BA/BS

Graduate degree preferred

PM certification preferred

Job description

Elevance Health in Columbus, OH is seeking a Program Manager for Ohio Claims to lead Medicaid claims configuration, rate changes, compliance and contractual updates. The role coordinates with claims, provider experience, utilization management, regulatory teams, and call center leads to resolve policy and reimbursement issues.

The position requires a BA/BS and at least 5 years of external client facing program management experience.