Provider Reimbursement Manager

Elevance Health

Provider Reimbursement Manager managing key components of provider reimbursement strategy for Elevance Health. Collaborating with Medicaid markets to ensure compliance and improve cost of care performance.

Posted 6/10/2026full-timeLouisville • Kentucky, Ohio • 🇺🇸 United StatesSeniorLead💰 $80,940 - $153,360 per yearWebsite

About the role

Key responsibilities & impact

Manages key components of the provider reimbursement strategy
Serves as the primary point of contact for assigned Medicaid markets
Lead ongoing collaboration with markets to ensure prepay edit compliance
Identify and drive opportunities to improve cost of care performance
Support onboarding of new Medicaid markets
Maintain and continuously enhance a centralized repository of state-specific edit requirements
Act as a subject matter expert on prepay editing
Monitor performance and compliance across assigned markets

Requirements

What you’ll need

Requires a BA/BS degree in a related field
a minimum of 7 years reimbursement experience including performing detailed financial modeling and economic analyses
CPC, RHIT, or RHIA certifications preferred
Deep, working knowledge of prepay editing within Elevance
Strong understanding of correct coding initiatives (CCI)
direct experience interpreting and operationalizing state Medicaid guidelines
proven experience onboarding new Medicaid markets
ability to influence without authority and drive alignment across market leadership, operations, and enterprise teams
strong analytical and problem-solving skills

Benefits

Comp & perks

a comprehensive benefits package
incentive and recognition programs
equity stock purchase
401k contribution
merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical benefits
dental benefits
vision benefits
short and long term disability benefits
wellness programs
financial education resources

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

reimbursement strategyfinancial modelingeconomic analysesprepay editingcorrect coding initiativesstate Medicaid guidelinesonboardingperformance monitoringcompliance enhancement

Soft Skills

influence without authoritydrive alignmentanalytical skillsproblem-solving skillscollaboration

Certifications

BA/BS degreeCPCRHITRHIA