Provider Reimbursement Manager

Elevance Health (Anthem); Atlanta (GA); Hybrid; USD 110,000 - 150,000; Full time

Benefits offered by this job

merit increases

Paid Holidays

Paid Time Off

incentive bonus programs

medical

dental

vision

401(k) +match

stock purchase plan

life insurance

wellness programs

financial education resources

Job summary

Elevance Health is seeking a Provider Reimbursement Manager to lead fee schedule development and complex reimbursement modeling in a hybrid role, with proximity to an eligible office. You will collaborate with Health Service Area, actuarial, decision support, and underwriting to align cost of care with pricing and financial plans.

The ideal candidate has a BA/BS and at least 7 years of reimbursement experience, with strong financial modeling and economic analysis skills; CPC or CIC certification

Qualifications

• Requires a BA/BS degree in a related field and a minimum of 7 years reimbursement experience; or equivalent combination of education and experience.

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 accurate cost of care targets are incorporated into product pricing and financial plans.
• Performs and/or directs complex fee modeling exercises to ensure that projected unit reimbursement changes meet corporate cost 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, improve service, and reduce administrative expenses.
• Manages special projects and initiatives.

Skills

Financial modeling

Economic analyses

Reimbursement experience

Education

BA/BS degree

Job description

Provider Reimbursement Manager

Anticipated End Date: 2026-10-11

LOCATION

This is a hybrid role. Eastern or Central time zone highly preferred. You should be within a reasonable proximity to an eligible office.

HOURS

General business hours, Monday through Friday.

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.

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.

Primary duties may include, but are not limited to :

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

Required 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, which would provide an equivalent background.

Preferred Qualifications

• You must be CPC or CIC certified to be considered for this position.
• WGS and/or GBD Facets experience preferred.
• Experience working post-pay reviews, validation, and recovery processes in the healthcare industry strong preferred.
• Experience managing multiple projects in various stages to completion strongly preferred.
• Claim processing and adjustment experience strongly preferred.
• You should be comfortable speaking to external stakeholders to present concepts, and be an SME on CoC.

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 our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs (unless covered by a collective bargaining agreement)
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment