Strategic Provider Reimbursement Lead

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

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