Provider Reimbursement Manager – CPC/CIC

Elevance Health

. Lead fee schedule development for specific plans and/or develop and implement clinical editing rules .

Posted 10/27/2026full-timeUnited StatesSeniorLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in reimbursement strategies, financial modeling, and cost-of-care analysis within the healthcare industry. Proven ability to collaborate with cross-functional teams and manage multiple projects effectively.

Highest-signal resume keywords

Reimbursement ExperienceFinancial ModelingCPC CertificationProject ManagementHealthcare Industry Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Fee Schedule DevelopmentClinical Editing RulesCost-of-Care AnalysisEconomic AnalysesPost-Pay ReviewsClaim ProcessingValidation ProcessesRecovery Processes

Soft Skills

CollaborationPresentation SkillsStakeholder Communication

Tools & Technologies

WGS FacetsGBD Facets

Certifications & Qualifications

CPC CertificationCIC Certification

Industry Keywords

HealthcareCost TargetsProvider Reimbursement StrategyNegotiationsAdministrative Expenses

About the role

Key responsibilities & impact

Lead fee schedule development for specific plans and/or develop and implement clinical editing rules
Collaborate 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 supporting 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
Minimum of 7 years reimbursement experience
Experience performing detailed financial modeling and economic analyses
CPC or CIC certification required
Eastern or Central time zone highly preferred
Must be within a reasonable proximity to an eligible office
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 in various stages to completion strongly preferred
Claim processing and adjustment experience strongly preferred
Comfortable speaking to external stakeholders to present concepts
Ability to serve as an SME on CoC

Benefits

Comp & perks

merit increases
paid holidays
Paid Time Off
incentive bonus programs
medical benefits
dental benefits
vision benefits
short and long term disability benefits
401(k) +match
stock purchase plan
life insurance
wellness programs
financial education resources
Hybrid work arrangement with virtual-work flexibility