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Provider Reimbursement Manager – Behavioral Health
Elevance HealthProvider Reimbursement Manager overseeing provider reimbursement strategy at Elevance Health. Ensuring accurate claims adjudication and leading policy development in behavioral health reimbursement.
About the role
Key responsibilities & impact- Managing key components of the provider reimbursement strategy and policy
- Ensures accurate adjudication of claims, by translating various complex coding, business and billing rules and standards into effective and accurate reimbursement policies
- Serves as subject matter expert regarding reimbursement policies, edits, behavioral health standards, billing, and coding conventions
- Leads policy development for specific plan(s) and/or the development and implementation of behavioral health reimbursement policy rules
- Works with multiple business areas to ensure that accurate cost of care targets are incorporated into the company's financial plans
- Performs and/or directs complex research to ensure that projected changes meet corporate cost targets
- Prepares and presents cost of care data analysis to support regions cost of care initiatives
- Develops and maintains the provider reimbursement policies that will lower the cost of care, improve service, and reduce administrative expenses
- Manages special projects and initiatives
Requirements
What you’ll need- Requires a BA/BS degree in a related field
- minimum of 7 years reimbursement experience including performing detailed financial modeling and economic analyses
- any combination of education and experience, which would provide an equivalent background
- CPC -Certified Professional Coder strongly preferred
- MBA or other equivalent advanced degree strongly preferred
- Strong behavioral health background preferred
- Strong critical thinking and analytical skills
- Understanding of pricing methodologies preferred
- Strong written and verbal communications
Benefits
Comp & perks- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
reimbursement strategyclaims adjudicationcoding conventionsbilling rulesfinancial modelingeconomic analysescost of care analysispolicy developmentbehavioral health standards
Soft Skills
critical thinkinganalytical skillswritten communicationverbal communication
Certifications
CPC - Certified Professional CoderMBA