Sign on Bonus:
$1,000
Location:
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.
Job Responsibilities:
Ensures accurate adjudication of claims by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
- Review medical record documentation in support of Evaluation and Management CPT codes.
- Review company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules. Conduct clinical research, data analysis, and legislative mandate identification to support draft development or revision of enterprise reimbursement policy.
- Translate medical policies into reimbursement rules.
- Perform CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and system edit implications.
- Coordinate research and respond to system inquiries and appeals.
- Research claims systems and system edits to identify adjudication issues and audit claims adjudication for accuracy.
- Prepare correspondence to providers regarding coding and fee schedule updates.
Minimum Requirements:
Requires a BA/BS degree and at least 2 years of related experience, or an equivalent combination of education and experience.
Preferred Skills and Certifications:
- Certified Professional Coder (CPC), CEMC, and CEDC encouraged.
Please note that Elevance Health only accepts resumes from agencies with a signed agreement. Unsolicited resumes are deemed property of Elevance Health.
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