Logo of Huzzle

Provider Reimbursement Administrator - Carelon Payment Integrity

Applications are closed

  • Job
    Full-time
    Junior (1-2 years)
  • Mason

Requirements

  • 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 Qualifications, Skills, and Experiences:
  • Registered Nurse with active licenses strongly preferred
  • Proficient in Excel and analytics highly desired
  • Ability to manipulate data files strongly desired
  • Coding certification preferred

Responsibilities

  • 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.
  • Translates medical policies into reimbursement rules.
  • 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.
  • Performs pre-adjudication claims reviews to ensure proper coding was used.
  • Prepares correspondence to providers regarding coding and fee schedule updates.
  • Trains customer service staff on system issues.
  • Works with provider contracting staff when new/modified reimbursement contracts are needed.

FAQs

Do we support remote work?

Yes, we support remote work in a hybrid format, requiring candidates to be in the office 1-2 days per week.

What is the primary role of the Provider Reimbursement Administrator?

The primary role of the Provider Reimbursement Administrator is to ensure accurate adjudication of claims by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.

What are the minimum experience requirements for this position?

The minimum requirement is a BA/BS degree and a minimum of 2 years related experience, or any combination of education and experience that would provide an equivalent background.

Is a coding certification preferred for this job?

Yes, a coding certification is preferred for this position.

Where is the ideal candidate expected to live?

The ideal candidate is expected to live within 50 miles of one of our pulse point locations.

What specific skills are highly desired for this role?

Proficiency in Excel and analytics, as well as the ability to manipulate data files, are highly desired skills for this role.

What is the salary range for this position?

The salary range for this position is $57,456 to $98,496, depending on various factors such as experience, education, and geographic location.

What kind of benefits does Elevance Health offer?

Elevance Health offers a comprehensive benefits package that includes medical, dental, vision, short and long-term disability benefits, a 401(k) match, stock purchase plan, life insurance, wellness programs, and more.

Are there any vaccination requirements for this position?

Yes, all new candidates in certain patient/member-facing roles are required to be vaccinated against COVID-19 unless an acceptable explanation is provided.

Who is Elevance Health?

Elevance Health is a health company dedicated to improving lives and communities, making healthcare simpler, and is a Fortune 25 company with a longstanding history in the healthcare industry.

Improving the health of humanity

Science & Healthcare
Industry
10,001+
Employees

Mission & Purpose

Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.   Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.  We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.

Get notified when Elevance Health posts a new role

Get Hired with Huzzle

Discover jobs with AI-powered precision. Autofill and track applications, create tailored resumes, and find the best opportunities across the web – all by simply chatting.

Already have an account?