Hybrid Provider Reimbursement Leader

Elevance Health; Grand Prairie (TX); Hybrid; USD 110,000 - 150,000; Full time

Job summary

Elevance Health is seeking a Provider Reimbursement Manager to lead cost-of-care initiatives and shape the reimbursement strategy across plans. You will coordinate with actuarial, decision support and underwriting teams to ensure pricing aligns with corporate targets, while guiding complex fee modeling and provider negotiations.

This hybrid role requires on-site presence 1–2 days weekly; proximity to an Elevance Health office is preferred.

Qualifications

• Requires a BA/BS degree in a related field and a minimum of 7 years reimbursement experience including performing detailed financial modeling and economic analyses; or any combination of education and experience providing an equivalent background.
• CPC or CIC certification is preferred for consideration.
• Experience with post-pay reviews, validation and recovery processes is strongly preferred.
• Experience managing multiple projects in various stages to completion is strongly preferred.
• Experience with claim processing and adjustment is strongly preferred.

Responsibilities

• Leads fee schedule development for specific plan(s) and/or the development and implementation of clinical editing rules.
• Works with Health Service Area, actuarial, decision support, and underwriting to ensure cost of care targets are incorporated into pricing and financial plans.
• Performs and/or directs complex fee modeling exercises to ensure projected unit reimbursement changes meet targets.
• Provides analytical support for hospital and physician negotiations.
• Prepares and presents cost of care data analysis to support regional cost of care initiatives.
• Develops and maintains the provider reimbursement strategy to lower cost of care and improve service.

Skills

Financial modeling

Economic analyses

Stakeholder communication

Project management

Education

BA/BS degree

Tools

WGS

GBD Facets

Job description

Elevance Health is seeking a Provider Reimbursement Manager to lead cost-of-care initiatives and shape the reimbursement strategy across plans. You will coordinate with actuarial, decision support and underwriting teams to ensure pricing aligns with corporate targets, while guiding complex fee modeling and provider negotiations.

This hybrid role requires on-site presence 1–2 days weekly; proximity to an Elevance Health office is preferred.