Elevance Health
Medical Claims Data Integrity Consultant
Elevance Health, Chicago, Illinois, United States, 60290
Overview
Anticipated End Date:
2025-10-24 Position Title:
Medical Claims Data Integrity Consultant Job Description:
Medical Claims Data Integrity Consultant Location:
Atlanta, GA; Norfolk, VA; Indianapolis, IN; Chicago, IL; Louisville, KY (preferred). 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 virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Hybrid/Virtual Work Policy:
Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Visa Sponsorship:
This position is not eligible for current or future visa sponsorship. Job Context:
The Medical Claims Data Integrity Consultant (Business Information Developer Consultant Senior) is viewed as an expert in the development and execution of data mining analyses. This position focuses on exploring AI applications to streamline processes and design solutions to prevent fraud, waste, and abuse (FWA) and over-payment.
Responsibilities
Undertakes complex assignments requiring additional specialized technical knowledge.
Conducts extensive research on CMS regulations, internal and external reimbursement, and medical/clinical policies, supported by official documents.
Establishes and communicates common goals and direction for the team.
Maintains advanced knowledge of data warehouse design, data definitions, system capabilities, and data integrity issues.
Acts as a source of direction, training and guidance for less experienced staff.
Analyzes pertinent claims and medical records.
Strong analytical skills with the ability to present findings and value to internal and external contacts, clients, or customers.
Develops and supports complex Data Warehouse-related applications for design and implementation of database tables.
Conducts training on the use of developed applications.
Maintains current industry knowledge of claim edit references, including AMA, CMS, and NCCI.
Minimum Requirements
Requires a BS/BA degree; minimum of 6 years experience; or any combination of education and experience that provides an equivalent background.
Preferred Skills, Capabilities, and Experiences
Experience with Enterprise Data Assets like CDP and AEDL is a plus.
Operational system knowledge (WGS, GBD FACETS).
Clinical Review: experience evaluating clinical content, documents, and protocols for accuracy and relevance, with recommendations for improvements.
Ability to apply industry coding guidelines to claims processes.
Experience in reviewing, analyzing, and researching coding issues and data reports to establish patterns for payment integrity.
Solid understanding of the claims workflow and its interconnection with claim forms.
Experience with Payment Integrity background.
Compensation and Benefits For candidates working in person or virtually in the location(s) below, the salary range for this position is $129,888 to $194,832. Locations: Chicago, IL. In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contributions (eligibility requirements apply). The salary range is based on legitimate, non-discriminatory factors and may be modified in the future based on geographic location, experience, education, and skill level. No wages or compensation are guaranteed until earned, vested, and determinable under applicable policies and plans.
The salary and benefits information provided is intended for illustrative purposes and may be adjusted by the Company in its sole discretion.
Job Details Job Level:
Non-Management Exempt Workshift:
1st Shift (United States of America) Job Family:
RDA > Business/Health Info
Compliance and Equal Opportunity Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Unsolicited resumes submitted to hiring managers are the property of Elevance Health.
About 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 looking for leaders who are passionate about making an impact on our members and the communities we serve.
How We Work:
We are building a culture designed to advance strategy and support personal and professional growth. Our values and behaviors drive our culture, business outcomes, and shared success for consumers, associates, communities, and the business.
We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, disability coverage, 401(k) with match, stock purchase plan, life insurance, wellness programs, and financial education resources.
Elevance Health operates a Hybrid Workforce Strategy. Associates are expected to work at a location at least once per week, with specific onsite requirements discussed during the hiring process.
COVID-19 and Influenza vaccination may be required for certain patient/member-facing roles. All candidates will be evaluated in accordance with federal, state, and local laws.
Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will be considered regardless of age, citizenship status, color, creed, disability, ethnicity, genetic information, gender identity or expression, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other protected status. Accommodation requests for the application process can be made to the health job support email: relevancehealthjobssupport@e relevancehealth.com
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Anticipated End Date:
2025-10-24 Position Title:
Medical Claims Data Integrity Consultant Job Description:
Medical Claims Data Integrity Consultant Location:
Atlanta, GA; Norfolk, VA; Indianapolis, IN; Chicago, IL; Louisville, KY (preferred). 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 virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Hybrid/Virtual Work Policy:
Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Visa Sponsorship:
This position is not eligible for current or future visa sponsorship. Job Context:
The Medical Claims Data Integrity Consultant (Business Information Developer Consultant Senior) is viewed as an expert in the development and execution of data mining analyses. This position focuses on exploring AI applications to streamline processes and design solutions to prevent fraud, waste, and abuse (FWA) and over-payment.
Responsibilities
Undertakes complex assignments requiring additional specialized technical knowledge.
Conducts extensive research on CMS regulations, internal and external reimbursement, and medical/clinical policies, supported by official documents.
Establishes and communicates common goals and direction for the team.
Maintains advanced knowledge of data warehouse design, data definitions, system capabilities, and data integrity issues.
Acts as a source of direction, training and guidance for less experienced staff.
Analyzes pertinent claims and medical records.
Strong analytical skills with the ability to present findings and value to internal and external contacts, clients, or customers.
Develops and supports complex Data Warehouse-related applications for design and implementation of database tables.
Conducts training on the use of developed applications.
Maintains current industry knowledge of claim edit references, including AMA, CMS, and NCCI.
Minimum Requirements
Requires a BS/BA degree; minimum of 6 years experience; or any combination of education and experience that provides an equivalent background.
Preferred Skills, Capabilities, and Experiences
Experience with Enterprise Data Assets like CDP and AEDL is a plus.
Operational system knowledge (WGS, GBD FACETS).
Clinical Review: experience evaluating clinical content, documents, and protocols for accuracy and relevance, with recommendations for improvements.
Ability to apply industry coding guidelines to claims processes.
Experience in reviewing, analyzing, and researching coding issues and data reports to establish patterns for payment integrity.
Solid understanding of the claims workflow and its interconnection with claim forms.
Experience with Payment Integrity background.
Compensation and Benefits For candidates working in person or virtually in the location(s) below, the salary range for this position is $129,888 to $194,832. Locations: Chicago, IL. In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contributions (eligibility requirements apply). The salary range is based on legitimate, non-discriminatory factors and may be modified in the future based on geographic location, experience, education, and skill level. No wages or compensation are guaranteed until earned, vested, and determinable under applicable policies and plans.
The salary and benefits information provided is intended for illustrative purposes and may be adjusted by the Company in its sole discretion.
Job Details Job Level:
Non-Management Exempt Workshift:
1st Shift (United States of America) Job Family:
RDA > Business/Health Info
Compliance and Equal Opportunity Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Unsolicited resumes submitted to hiring managers are the property of Elevance Health.
About 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 looking for leaders who are passionate about making an impact on our members and the communities we serve.
How We Work:
We are building a culture designed to advance strategy and support personal and professional growth. Our values and behaviors drive our culture, business outcomes, and shared success for consumers, associates, communities, and the business.
We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, disability coverage, 401(k) with match, stock purchase plan, life insurance, wellness programs, and financial education resources.
Elevance Health operates a Hybrid Workforce Strategy. Associates are expected to work at a location at least once per week, with specific onsite requirements discussed during the hiring process.
COVID-19 and Influenza vaccination may be required for certain patient/member-facing roles. All candidates will be evaluated in accordance with federal, state, and local laws.
Elevance Health is an Equal Employment Opportunity employer. Qualified applicants will be considered regardless of age, citizenship status, color, creed, disability, ethnicity, genetic information, gender identity or expression, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other protected status. Accommodation requests for the application process can be made to the health job support email: relevancehealthjobssupport@e relevancehealth.com
#J-18808-Ljbffr