Provider Reimbursement Admin (Evaluation and Management Coding/Auditing)

$57,456 - $98,496/Yr

Elevance Health - Tampa, FL

Full-time - Entry Level

Tampa, FL

Insurance Carriers and Related Activities

About the position

The Provider Reimbursement Admin (Evaluation and Management Coding/Auditing) ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. This position will work a hybrid model (remote and office) which requires working in the nearest Elevance Health office 1-2 times per week. The rest of the time would be working remotely (from home). Must live within 50 miles of one of our Elevance Health office locations.

Responsibilities

• 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.
• 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.

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.
• American Academy of Professional Coders (AAPC) CPC, CEMC or American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P coding certification is required.

Nice-to-haves

• Proficiency in Microsoft Word, Excel and SharePoint.
• EM Leveling audit experience preferred.
• Strong research skills and perform well independently and in a team setting.
• Experience working in a production environment with short timelines is strongly preferred.
• Knowledgeable of the application of Medicaid, Medicare or Commercial reimbursement policies and guidelines.
• FACETS or WGS experience preferred.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• Paid holidays
• Paid Time Off
• Medical, dental, vision benefits
• Short and long term disability benefits
• Life insurance
• Wellness programs
• Financial education resources