Provider Reimburse Admin Sr

Provider Reimbursement Admin Sr

Location:

Illinois (Hybrid – 1-2 days in office per week; remote availability based on commuting distance and accommodation).

$76,296.00/yr – $/yr

The Provider Reimbursement Admin Sr is responsible for ensuring accurate adjudication of claims by translating medical policies, reimbursement policies, and clinical editing policies into effective reimbursement criteria. Serves as subject matter expert on reimbursement policies, edits, and coding conventions.

• Works with vendors and enterprise teams to develop enterprise reimbursement policies and edits, ensuring alignment with Federal and state mandates.
• Collaborates with other departments to develop claims adjudication workflow and business process improvements.
• May lead the full range of provider reimbursement activities for a state(s).
• Leads projects related to provider reimbursement initiatives.
• Mentors less experienced administrators.

• BA/BS degree and at least 4 years of related experience; or equivalent combination of education and experience.

• Payment methodology knowledge.
• WGS knowledge.
• Ability to multitask and meet deadlines.

Elevance Health offers a comprehensive benefits package including health, dental, vision, disability insurance, 401(k) with match, stock purchase plan, equity stock purchase, incentive and recognition programs, and financial education resources. Eligibility is subject to standard criteria.

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 protected status. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.