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Provider Reimbursement Manager
Elevance Health. Lead fee schedule development for specific plans and/or develop and implement clinical editing rules .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in reimbursement strategies, financial modeling, and cost-of-care analysis within the healthcare industry. Proven ability to lead projects, collaborate with cross-functional teams, and effectively communicate with stakeholders.
Highest-signal resume keywords
Reimbursement Strategy DevelopmentFinancial ModelingCPC CertificationHealthcare Industry ExperienceProject Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Fee Schedule DevelopmentCost-of-Care AnalysisComplex Fee ModelingEconomic AnalysisClaim ProcessingPost-Pay ReviewsValidation ProcessesRecovery Processes
Soft Skills
Stakeholder CommunicationPresentation Skills
Tools & Technologies
WGS FacetsGBD Facets
Certifications & Qualifications
CPC CertificationCIC Certification
Industry Keywords
HealthcareCost TargetsProvider ReimbursementAdministrative ExpensesNegotiation Support
About the role
Key responsibilities & impact- Lead fee schedule development for specific plans and/or develop and implement clinical editing rules
- Work with Health Service Area, actuarial, decision support, and underwriting teams to incorporate accurate cost-of-care targets into product pricing and financial plans
- Perform and/or direct complex fee modeling exercises to ensure projected unit reimbursement changes meet corporate cost targets
- Provide analytical support for hospital and physician negotiations
- Prepare and present cost-of-care data analysis for regional cost-of-care initiatives
- Develop and maintain provider reimbursement strategy to lower cost of care, improve service, and reduce administrative expenses
- Manage special projects and initiatives
Requirements
What you’ll need- BA/BS degree in a related field and a minimum of 7 years reimbursement experience, including detailed financial modeling and economic analyses; or an equivalent combination of education and experience
- CPC or CIC certification required
- Eastern or Central time zone highly preferred
- Must be within reasonable proximity to an eligible office and reasonable commuting distance from a posting location
- WGS and/or GBD Facets experience preferred
- Experience with post-pay reviews, validation, and recovery processes in the healthcare industry strongly preferred
- Experience managing multiple projects through completion strongly preferred
- Claim processing and adjustment experience strongly preferred
- Comfortable speaking to external stakeholders to present concepts
- Subject matter expertise on CoC
- General business hours, Monday through Friday
- COVID-19 and Influenza vaccination may be required for certain patient/member-facing roles
Benefits
Comp & perks- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) with company match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Hybrid work arrangement with virtual-work flexibility