- 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.
- 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.
- American Academy of Professional Coders (AAPC)
- 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.
- FACETS or WGS experience preferred.
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Provider Reimbursement Admin - WINSTON, United States - Elevance Health
Description
Provider Reimbursement AdminLocation:
This position will work a hybrid model (remote and office) and has an on-site requirement of 1-2 days/week. The ideal candidate will reside within 50 miles or 1-hour commute each way to an Elevance Health PulsePoint location.
The Provider Reimbursement Admin ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
Primary duties may include, but are not limited to:
Minimum Requirements:
Preferred Skills, Capabilities and Experiences:
RHIA, RHIT, CCS, CCS-P coding certification preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with 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.
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 market-competitive 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.
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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. 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.