at Elevance Health in CHICAGO, Illinois, United States
Job Description
Provider Reimbursement Manager - Carelon Payment Integrity
Location: The ideal candidate will live within 50 miles of one of our pulse point locations and will work on a hybrid work model (1-2 days per week in the office).
Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate, and prevent unnecessary medical-expense spending.
The Provider Reimbursement Manager manages key components of the provider reimbursement strategy.
How you will make an impact:
+ 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 region’s cost-of-care initiatives.
+ Develop and maintain the provider reimbursement strategy that will lower the cost of care, improve service, and reduce administrative expenses.
+ Manages special projects and initiatives.
Minimum Requirements:
+ 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 Skills, Qualifications, and Experiences:
+ CPA, MGA MBA, or other equivalent advanced degree strongly preferred.
+ Registered Nurse with current active license highly desired.
+ Experience performing Hospital Bill Audits, which includes comparing an itemized bill/UB04 to Medical Records strongly preferred.
+ Experience with a vendor performing Hospital Bill Audits or Itemized Bill Reviews desired.
+ Experience working with a Payment Integrity vendor that conducts audits on behalf of payers preferred.
For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $86,520 to $148,320.
Locations: California; Colorado; District of Columbia (Washington, DC); Nevada; New York; Washington State
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, 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.
