Join to apply for the Provider Reimbursement Adm-CPC role at Elevance Health
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Join to apply for the Provider Reimbursement Adm-CPC role at Elevance Health
Sign on Bonus: $1,000. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. This position is not eligible for employment based sponsorship. Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. PRIMARY DUTIES: Review medical record documentation in support of Evaluation and Management CPT codes. 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. Translates medical policies into reimbursement rules. 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. Prepares correspondence to providers regarding coding and fee schedule updates. Minimum Requirements: 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. Preferred Skills, Capabilities and Experience: Certified Professional Coder (CPC) CEMC and CEDC encouraged.
Seniority level
Seniority level
Entry level
Employment type
Employment type
Full-time
Job function
Job function
Finance and Sales-
Industries
Hospitals and Health Care
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