Program Manager- Ohio 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

Program Manager- Ohio Claims

Program Manager-Ohio MyCare Location: It is required to reside in Ohio. 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. 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 accommodation is granted as required by law.

The Program Manager will be responsible for Ohio Claims for Medicaid line of business, ensuring resolution to claims configuration issues, rate changes, compliance and contractual updates. Program managers typically support business strategies through an integrated portfolio of external client facing projects or initiatives. A program manager may have responsibility for a piece of a larger enterprise/regional external client facing program.

How you will make an impact

• Work collaboratively with claims teams, provider experience, utilization management, regulatory and call center leads to resolve issues and concerns as they relate to claims policies, reimbursement policies, codes requiring authorizations, and provider complaints.
• Accountable for on time delivery of regulatory reports related to claims (i.e. Prompt Pay, Claims Disputes and others).
• Manages and coordinates the development, approval, implementation and compliance of on-going external client facing programs.
• Researches applicable subject matter practices and remains aware of industry trends.
• Manages external client facing relationships and partners with corporate and regional business areas.
• Develops program success measures and performs periodic assessments of program success.
• Oversee the end-to-end claims process, including receipt, adjudication, payment, and performance reporting on claims timeliness, accuracy, backlog and provider payment compliance.
• Serve as the operational liaison with the state of Ohio, Provider Experience, and internal executive leadership.

Minimum Requirements

• Requires a BA/BS and minimum of 5 years external client facing experience in program/project management; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences

• Graduate degree preferred.
• Project management certification preferred.
• Strong understanding of Dual (Medicare and Medicaid) claims configuration & adjudication is strongly preferred.
• Experience with regulatory reporting development, accuracy, and submission preferred.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $92,720.00 to $139,080.00. Location(s): Columbus, OH

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 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: 1st Shift (United States of America)

Job Family: BSP > Program/Project

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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact.

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.

Please visit the Contract Worker Community Page.

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