Location: open to any Elevance Health office location
**this position will work a hybrid model (remote and office) which requires working in the nearest Elevance Health office 1-2 days per week. The rest of the time would be working remotely (from home). Must live within 50 miles of one of our Elevance Health office locations. **Open to any Elevance Health office**
The Provider Reimburse Admin ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
How You Will Make an Impact:
Reviews company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules, as well as conducts clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
Coordinates research and responds to system inquiries and appeals.
Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
Minimum Requirements:
Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Coding Certification Strongly preferred
Proficiency in Microsoft Word, Excel and SharePoint.
EM Leveling audit experience preferred.
Strong research skills and perform well independently and in a team setting
Experience working in a production environment with short timelines is strongly preferred.
Knowledgeable of the application of Medicaid, Medicare or Commercial reimbursement policies and guidelines.
