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Medical Claims Administrator

2 months ago

Roanoke, Virginia, United States Elevance Health Full time
Job Summary

We are seeking a skilled Healthcare Reimbursement Specialist to join our team at Elevance Health. As a key member of our reimbursement team, you will play a critical role in ensuring accurate and timely reimbursement of medical claims.

Key Responsibilities
  • Review and analyze medical policies, reimbursement policies, and clinical editing policies to ensure accurate reimbursement criteria.
  • Conduct research and data analysis to support the development and revision of enterprise reimbursement policy.
  • Perform CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, and reimbursement implications.
  • Coordinate research and respond to system inquiries and appeals.
  • Audit claims adjudication for accuracy and identify adjudication issues.
Requirements
  • Bachelor's degree in a related field, such as healthcare administration or finance.
  • Minimum of 2 years of experience in medical claims administration or a related field.
  • Coding certification, such as CPC, CEMC, RHIA, RHIT, CCS, or CCS-P.
Preferred Skills
  • Proficiency in Microsoft Word, Excel, and SharePoint.
  • Experience with EM Leveling audits.
  • Strong research skills and ability to work independently and in a team setting.
  • Knowledge of Medicaid, Medicare, or Commercial reimbursement policies and guidelines.
About Elevance Health

Elevance Health is a health company dedicated to improving lives and communities. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

We offer a range of market-competitive total rewards, including merit increases, paid holidays, Paid Time Off, and incentive bonus programs. We also offer medical, dental, vision, short and long term disability benefits, 401(k) + match, stock purchase plan, life insurance, wellness programs, and financial education resources.

Elevance Health operates in a Hybrid Workforce Strategy, requiring associates to work at an Elevance Health location at least once per week. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.