Provider Reimbursement Manager (Hospital Audits)

Anticipated End Date:

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Job Description:

Provider Reimbursement Manager (Hospital Audit) JR149902

Location: This role requires associates to be inoffice 1 day per week fostering collaboration and connectivity while providing flexibility to support productivity and worklife balance. This approach combines structured office engagement with the autonomy of remote work promoting a dynamic and adaptable workplace. Alternate locations may be considered.

The Provider Reimburse Manager manages key components of the provider reimbursement strategy. Primary duties may include but are not limited to:

• Leads fee schedule development and/or the development and implementation of clinical editing rules.

• Works with the Health Service Area actuarial decision support and underwriting to ensure that accurate cost of care targets are incorporated into product pricing and the companys financial plans.

• Performs and/or directs complex fee modeling exercises to ensure that projected unit reimbursement changes meet corporate cost targets.

• Provides analytical support for hospital and physician negotiations.

• Prepares and presents cost of care data analysis to support the regions cost of care initiatives.

• Develops and maintains the provider reimbursement strategy that will lower the cost of care improve service and reduce administrative expenses.

• Manages special projects and initiatives.

Minimum Requirements:

• Requires a BA/BS degree in a related field and a minimum of 7 years reimbursement experience including performing detailed financial modeling and economic analyses; or any combination of education and experience which would provide an equivalent background.

Preferred Qualifications:

• RN or LPN preferred.

• Experience working with WGS a plus.

• Hospital Bill Auditing and Quality Review experience preferred.

• Managed Care/Health insurance industry experience.

• CPA MGA MBA or other equivalent advanced degree strongly preferred.

For candidates working in person or virtually in the below location(s) the salary* range for this specific position is $83280 to $149904

Locations:California; Colorado; Illinois; Minnesota; New York

In addition to your salary Elevance Health offers benefits such as a comprehensive benefits package incentive and recognition programs equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate nondiscriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender race or any other category protected by federal state and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location work experience education and/or skill level. Even within the range the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned vested and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus commission benefits or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

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Workshift:

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Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success for our consumers our associates our communities and our business.

We offer a range of marketcompetitive total rewards that include merit increases paid holidays Paid Time Off and incentive bonus programs (unless covered by a collective bargaining agreement) medical dental vision short and long term disability benefits 401(k) match stock purchase plan life insurance wellness programs and financial education resources to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/memberfacing roles to become vaccinated against COVID19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.