Provider Reimburse Admin SR - Provider Exceptions

Elevance Health (Anthem); Norfolk (VA); Híbrido; USD 71.000 - 117.000; Tempo integral

Benefícios oferecidos por esta vaga

Sign-on bonus $5,000

Resumo da vaga

Elevance Health is seeking a Provider Reimburse Admin SR - Provider Exceptions in Virginia with a focus on accurate adjudication of claims and translating policies into reimbursement criteria. The role involves policy interpretation, edits, and coding conventions, collaborating with vendors and enterprise teams to ensure compliant reimbursement processes.

The position is hybrid, requiring 1–2 days in office weekly, with consideration for within-distance applicants.

Qualificações

• Requires a BA/BS degree and a minimum of 4 years related experience.
• 4+ years provider contracting experience preferred.
• 5+ years prepay claims editing experience preferred.
• AAPC or AHIMA certification preferred.
• Strong attention to detail and stakeholder communication.

Responsabilidades

• Fields provider prepay edit exception requests, evaluating against provider contract for accuracy and appropriateness and overseeing the implementation and ongoing maintenance of the provider exceptions.
• Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring policies and edits do not conflict with Federal and state mandates.
• Works with other departments on claims adjudication workflow development and business process improvements.
• May lead the full range of provider reimbursement activities for a state(s).
• Leads projects related to provider reimbursement initiatives.
• Serves as a mentor to less experienced administrators.

Conhecimentos

Attention to detail

Public speaking

Stakeholder engagement

Communication skills

Formação

BA/BS degree

AAPC or AHIMA certification

Descrição da vaga

Provider Reimburse Admin SR - Provider Exceptions

Position Title: Provider Reimburse Admin SR - Provider Exceptions

Job Description: Provider Reimburse Admin SR - Provider Exceptions

Sign On Bonus: $5,000

Hybrid : 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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

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.

The Provider Reimburse Admin SR ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Serves as subject matter expert regarding reimbursement policies, edits, and coding conventions.

How you will make an impact:

• Fields provider prepay edit exception requests, evaluating them against the provider contract for accuracy and appropriateness and overseeing the implementation and ongoing maintenance of the provider exceptions.
• Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring policies and edits do not conflict with Federal and state mandates.
• Works with other departments on claims adjudication workflow development and business process improvements.
• May lead the full range of provider reimbursement activities for a state(s).
• Leads projects related to provider reimbursement initiatives.
• Serves as a mentor to less experienced administrators.

Minimum Requirements:

• Requires a BA/BS degree and a minimum of 4 years related experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• 3+ years of provider contracting experience.
• 5+ years of prepay claims editing experience (implementing, approving, or testing).
• AAPC or AHIMA certification.
• Attention to detail.
• Strong public speaking/stakeholder engagement skills.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $70,800 to $116,820

Locations: Illinois; Maryland; Virginia

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, paid time off, stock, 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

Job Family: PND > Pricing Configuration

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

Anticipated End Date: 2026-11-23