Provider Reimbursement Manager

Elevance Health

Provider reimbursement manager optimizing healthcare pricing and cost-of-care strategies for Elevance Health, a healthcare company simplifying care. Leading fee modeling, negotiations, and reimbursement initiatives.

Posted 8/5/2026full-timeRemote • Montana, Ohio, Tennessee • 🇺🇸 United StatesSeniorLeadWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in reimbursement strategies, financial modeling, and cost-of-care analysis, with a strong ability to present complex data to stakeholders. Proven experience in managing projects and collaborating with cross-functional teams in the healthcare industry.

Highest-signal resume keywords

CPC CertificationFinancial ModelingCost-Of-Care AnalysisProject ManagementClaim Processing

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Reimbursement StrategiesFee Schedule DevelopmentClinical Editing RulesCost TargetsEconomic AnalysesPost-Pay ReviewsValidation ProcessesRecovery Processes

Soft Skills

Presentation SkillsCollaboration

Tools & Technologies

WGS FacetsGBD Facets

Certifications & Qualifications

CPCCIC

Industry Keywords

Healthcare IndustryCost-Of-Care InitiativesProvider ReimbursementHospital Negotiations

About the role

Key responsibilities & impact

Lead fee schedule development for specific plans and/or develop and implement clinical editing rules
Work with Health Service Area, actuarial, decision support, and underwriting teams to incorporate accurate cost-of-care targets into product pricing and financial plans
Perform and/or direct complex fee modeling exercises to ensure projected unit reimbursement changes meet corporate cost targets
Provide analytical support for hospital and physician negotiations
Prepare and present cost-of-care data analysis supporting regional cost-of-care initiatives
Develop and maintain provider reimbursement strategies to lower cost of care, improve service, and reduce administrative expenses
Manage special projects and initiatives
Present concepts to external stakeholders and serve as a subject matter expert on cost of care

Requirements

What you’ll need

BA/BS degree in a related field and a minimum of 7 years of reimbursement experience, including detailed financial modeling and economic analyses; or an equivalent combination of education and experience
CPC or CIC certification required for consideration
WGS and/or GBD Facets experience preferred
Experience with post-pay reviews, validation, and recovery processes in the healthcare industry strongly preferred
Experience managing multiple projects through completion strongly preferred
Claim processing and adjustment experience strongly preferred
Comfortable presenting concepts to external stakeholders
Subject matter expertise in cost of care
Ability to work general business hours, Monday through Friday
Candidates must reside within reasonable commuting distance of an eligible office unless an accommodation is granted
Eastern or Central time zone highly preferred

Benefits

Comp & perks

Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
Medical benefits
Dental benefits
Vision benefits
Short-term disability benefits
Long-term disability benefits
401(k) with company match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources
Flexible virtual work arrangement
Required in-person training sessions supporting onboarding and skill development