Clinical Content and Editing Reimbursement Manager

Elevance Health

Clinical Content & Editing Reimbursement Manager at Elevance Health managing provider reimbursement strategies and clinical editing rules for payment accuracy and compliance.

Posted 7/2/2026full-timeNorfolk • Florida, Illinois, Ohio, Virginia • 🇺🇸 United StatesSeniorLead💰 $80,940 - $140,580 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in reimbursement strategies, clinical content development, and financial modeling, with a strong focus on collaboration across cross-functional teams. Proficient in analyzing CMS regulations and leading continuous improvement initiatives in payment integrity and coding.

Highest-signal resume keywords

Reimbursement ExperienceFinancial ModelingClaims EditingCoding CredentialSQL Query Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Reimbursement StrategiesFinancial ModelingClaims EditingBillingCodingRevenue CycleClaims AdjudicationData ValidationAnalytical SkillsProblem-Solving Skills

Soft Skills

CollaborationLeadership

Tools & Technologies

Microsoft ExcelPivotTablesVLOOKUPXLOOKUP

Certifications & Qualifications

CCSCCS-PCPCCPBCIC

Industry Keywords

CMS RegulationsPayment IntegrityClinical Content DevelopmentScaled Agile Framework

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Managing development and execution of clinical content and provider reimbursement strategies
Leading development for specific plans and clinical editing rules
Preparing and presenting reimbursement, coding, payment integrity, and cost-of-care analyses
Collaborating with Clinical Content, Engineering, Product, and Data teams
Researching and interpreting CMS regulations and industry references
Overseeing validation activities to confirm reimbursement methodologies
Managing special projects and continuous improvement efforts

Requirements

What you’ll need

Requires BA/BS degree in related field
Minimum of 7 years reimbursement experience, including detailed financial modeling and economic analyses
5+ years of claims editing, payment integrity, or clinical content development experience preferred
Expertise in billing, coding, revenue cycle, and claims adjudication preferred
Nationally recognized coding or billing credential (CCS, CCS-P, CPC, CPB, or CIC)
Strong analytical and problem-solving skills
Intermediate proficiency with Microsoft Excel (including PivotTables, VLOOKUP/XLOOKUP)
SQL query and data validation experience preferred
Demonstrated ability to lead cross-functional initiatives
Scaled Agile Framework (SAFe) experience preferred.

Benefits

Comp & perks

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