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Reimbursement Policy Specialist

1 month ago

Miami, Florida, United States Elevance Health Full time

About the Role


At Elevance Health, we are seeking a highly skilled Reimbursement Policy Specialist to join our team. This role will be based in one of our office locations and will require working from home 2-3 days per week. If you have a passion for healthcare and enjoy working in a dynamic environment, this could be the perfect opportunity for you.



Job Description

We are looking for an experienced Reimbursement Policy Specialist who can effectively translate medical policies, reimbursement policies, and clinical editing policies into accurate and effective reimbursement criteria. The ideal candidate will have a strong understanding of the application of Medicaid, Medicare or Commercial reimbursement policies and guidelines.



Responsibilities

  • Review company-specific, CMS-specific, and competitor-specific medical policies, reimbursement policies, and editing rules to support draft development and/or revision of enterprise reimbursement policy.
  • Conduct research and data analysis to identify legislative mandates and develop recommendations for reimbursement policy updates.
  • Analyze CPT/HCPCS code and fee schedule updates to ensure accurate coverage and reimbursement.
  • Coordinate research and respond to system inquiries and appeals.
  • Conduct claims system audits to identify adjudication issues and ensure accurate reimbursement.


Requirements

  • Bachelor's degree in Healthcare Administration, Finance, or related field.
  • A minimum of 2 years of experience in reimbursement policy or a related field.
  • Coding certification required (AAPC CPC, CEMC or AHIMA RHIA, RHIT, CCS, CCS-P).
  • Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and SharePoint.
  • Strong analytical and problem-solving skills with ability to work independently and collaboratively as part of a team.


Benefits

  • A competitive salary range of $65,000-$85,000 per year, depending on experience.
  • A comprehensive benefits package, including medical, dental, vision, and 401(k) matching.
  • The opportunity to work in a hybrid work environment, with flexible scheduling and remote work options.
  • Access to ongoing training and development opportunities to enhance your skills and knowledge.
  • A collaborative and supportive work environment with a team of dedicated professionals.


About Elevance Health

Elevance Health is a leading health company dedicated to improving lives and communities. We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. Our values and behaviors are designed to advance our strategy and drive shared success for our consumers, associates, communities, and business.



Please note that all new candidates must become vaccinated against COVID-19 as part of our commitment to the health and well-being of our associates and communities. Elevance Health is an Equal Employment Opportunity employer and welcomes applications from diverse candidates.