Elevance Health

Bilingual

• Provides primary and urgent health care via telephone and tele video modalities to patients
• Develops and implements clinical plans of care for adult patients
• Gathers history and physical exam and diagnostics as needed
• Identifies and closes gaps in care
• Meets the patient's and family's physical and psychosocial needs
• Educates patients and families about medication usage, side effects, illness progression
• Maintains contact with other clinical team members and medical records
• Participates in continuing education as required by state and certifying body
• Prescribes medication as permitted by state prescribing authority

Advance Practice Provider, Nurse Practitioner – Bilingual

Vice President

• Provide analytical and strategic decision support to identify business opportunities
• Lead and mentor a multidisciplinary team of analytics professionals
• Oversee delivery of tailored, data-driven insights to support strategy and outcomes improvement
• Design program evaluation frameworks to assess effectiveness, ROI, and outcomes of key initiatives
• Ensure stakeholders have reliable access to high-quality analytic solutions
• Serve as a trusted thought partner and primary analytics point-of-contact for senior leaders

Staff VP, Advanced Analytics

Manager

• Manage a team that audits, reviews, and codes medical records for reimbursement and compliance
• Develop, implement, and monitor policies, procedures, and systems for proper coding and quality assurance
• Manage workloads, training, and problem resolution
• Oversee daily operations and ensure compliance
• Develop and implement systems to maintain records for the operating unit
• Manage projects to improve billing practices and increase revenues
• Assist physicians and providers with coding and billing questions
• Conduct individual and group provider in-service programs
• Conduct quality control studies and audits and implement solutions
• Train staff on coding, documentation, and billing regulations
• Participate in developing and maintaining policies and objectives
• Hire, train, coach, counsel, and evaluate direct reports

Manager, Medical Coding Analysis

• Responsible for leading coding team operations to drive high-quality documentation of clinical encounters and ensure adherence to the latest diagnostic documentation guidelines and clinical best practices.
• Serves as the primary resource and subject matter expert on all Medicare and Medicaid clinical documentation.
• Participates in all consultations related to coding and clinical documentation and creation of policy briefs for leadership.
• Executes day-to-day coding operations and ensures high-quality coding of diagnoses against ICD-10 and CPT classification systems.
• Drives high performance on coding team KPIs (e.g., turnaround times, claim denial rate due to technical issues, secondary review scores).
• Develops and iterates team workflows, KPIs, and associated reporting to meet quarterly goals for coding timeliness and quality.
• Maintains high performance through operational efficiency and ongoing business optimization.
• Develops and implements strategy for quality reviews of coder performance and associated coaching.

Manager, Coding & Documentation Analysis

Customer Support

• Responds to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility and claims
• Analyzes problems and provides information/solutions
• Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database
• Thoroughly documents inquiry outcomes for accurate tracking and analysis
• Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
• Researches and analyzes data to address operational challenges and customer service issues
• Provides external and internal customers with requested information
• Under immediate supervision, receives and places follow-up telephone calls / e-mails to answer customer questions that are routine in nature

Customer Care Representative I – Bilingual, Spanish

• Manages resource utilization to ensure appropriate delivery of care to members
• Coordinates service delivery to include member assessment of physical and psychological factors
• Participates in cross-functional workgroups created to maintain and develop program
• Evaluates current processes of Special Program's support functions; recommends changes for increased efficiencies and improved outcomes
• Develops and conducts training programs for staff involved in the program
• Extracts and manipulates analytical data to present findings to relevant markets and stakeholders
• Hires, trains, coaches, counsels, and evaluates performance of direct reports

Special Programs Manager I – Foster Care

Claims Specialist

• keying, processing health claims in accordance with claims policies and procedures
• able to handle more complex claim with a good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regs, coordination of benefits, healthcare terminology
• adjust claims
• reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement
• researches and analyzes claims issues
• responds to inquiries, may involve customer/client contact

Claims Representative II – Health & Dental

• Proactive and/or retroactive patient scheduling
• Maximize home-based provider availability and ensure timely patient visits
• Support providers by answering emails and inbound calls
• Assist with HEDIS gap closures and HRA compliance
• Multi-tasking including handling calls, texts, facsimiles, and electronic queues

Care Support Specialist I

Pharmacist

• Verifies member information and inputs data for the pharmacists
• Serves as mentor for less experienced staff
• Serves as department representative on intra-departmental initiatives
• Assists in formal training of associates and process improvement initiatives
• Conducts reviews by utilizing appropriate scripted algorithms in compliance with department guidelines
• Develops working partnerships with physicians and healthcare service providers
• Refers treatment plans to peer clinical reviewers in accordance with established criteria/guidelines

Pharmacy Technician II, BioPlus Specialty Pharmacy

Sales

• Works closely with leadership to oversee the sales efforts.
• Establishes relationships with functional areas within the company and partners with key stakeholders.
• Leads and mentors sales team by developing key growth action strategies, tactics, and action plans.
• Achieves projected regional sales targets and objectives as they pertain to overall business goals.
• Achieves sales effectiveness by meeting or surpassing gross profit and referral goals.
• Communicates information and issues regarding competitors and/or business to leadership.
• Develops and executes sales meetings.
• Assists in formulating market strategy to include marketing plans and materials.
• Participates in and/or leads various training programs offered by the company and/or outside organizations.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Director I – Sales

Compliance

• The Business Consultant is responsible for serving as the liaison between Provider Solutions, Health Economics, and Contract Administration
• May lead teams of analysts assigned to complex projects
• Acts as a resource to Provider Solutions, Contract Management, and Health Economics
• Analyzes and designs solutions to address complex business needs
• Develops project plans and coordinates resources
• Lead the strategy and execution of recovery workflows for Contract Compliance and Chargemaster variances
• Locate, review, and interpret complex contracts

Business Consultant – Contract Compliance, Strategy

Security Engineer

• Leads system and network architecture support for enterprise information security technologies
• including encryption, tokenization, and key management platforms across hybrid cloud and on-prem environments
• Leads development and execution of risk assessment methodologies to fit business, regulatory, and technical environment considerations
• Leads the development of requirements, system architecture, and software design of security products and services
• including secure data protection integration patterns for enterprise applications
• Leads the development of strategies for discovery, evaluation and response to new networking attacks
• Develops security incident response plans and strategies
• Provides trouble resolution and serves as point of technical escalation on complex problems
• Creates presentations and seeks IT management approval and acceptance of significant replacements or reconfigurations of major security systems
• Sets vendor strategy and direction
• Designs & engineers comprehensive access management and network security technical solutions
• Develops reports supporting strategy and direction for management
• Acts as a subject matter expert among peers, with manager and senior management on data protection technologies

Senior Information Security Advisor – Data Protection Engineer

QA Automation Engineer

• Develops, recommends, and implements enterprise information security policies, technical standards, guidelines, procedures, and integration solutions
• Responsible for the design, development, and delivery of scalable cloud-native integration services, secure API frameworks, and automation solutions
• Supports system and network architecture initiatives for information and network security technologies
• Supports the development and execution of risk assessment methodologies to fit business, regulatory, and technical environment considerations
• Contributes to requirements gathering, system architecture, and software design activities for security products and services
• Assists with the discovery, evaluation, and response to emerging networking threats and security vulnerabilities
• Develops security incident response plans and strategies
• Provides trouble resolution and serves as point of technical escalation on complex problems
• Creates presentations and seeks IT management approval and acceptance of significant replacements or reconfigurations of major security systems serving the Enterprise
• May be assigned to project teams for technical consultation to business partners and developers
• Designs & engineers comprehensive access management and network security technical solutions based on business requirements and defined technology standards
• Develops reports supporting strategy and direction for management

Senior Information Security Advisor – Automation Engineer

Consultant

• Conduct detailed evaluations of provider practices to determine current capabilities in value-based care
• Engage in a continuous process that includes assessment, analysis, strategy development, implementation, and outcomes tracking for each provider
• Assist providers with executing action plans focused on population health management
• Lead collaborative meetings with provider staff and internal stakeholders
• Create and deliver tailored learning opportunities for providers
• Educate providers on using proprietary tools, data, and technology
• Utilize data analytics to continuously monitor and track key performance metrics
• Accurately document all action plans, interventions, and provider activities in Salesforce
• Cultivate and maintain strong, long-term relationships with physicians and healthcare systems
• Advise executives on developing segment-specific strategies affecting provider success
• Exercise independent judgment on complex issues

Senior Care Consultant, Value-Based Provider Success

General Counsel

• Serve as a principal legal advisor on strategic transactions
• Oversee the legal aspects of the full transaction lifecycle
• Provide comprehensive legal guidance for corporate transactions
• Assess and minimize transaction risks
• Lead all phases of mergers, acquisitions, divestitures, and strategic investments
• Draft, review and negotiate complex deal documents
• Manage and coordinate legal due diligence
• Ensure compliance with regulatory matters
• Deliver subject-matter expertise to business units
• Help develop and implement an M&A playbook