Admin evaluation and management?/auditing
Position: Admin evaluation and management / auditing
SIGN-ON BONUS: Up to $5,000
Location: 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.
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.
How You Will Make An Impact
Primary duties may include, but are not limited to:
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.
Minimum 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.
Preferred Skills, Capabilities And Experiences
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.
For candidates working in person or remotely in the below location(s), the salary range for this specific position is $57,456 - $98,496.
Locations: California;
Colorado, Illinois, Minnesota, Nevada;
New York;
Washington State.
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements
#J-18808-Ljbffr
Apply Now
SIGN-ON BONUS: Up to $5,000
Location: 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.
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.
How You Will Make An Impact
Primary duties may include, but are not limited to:
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.
Minimum 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.
Preferred Skills, Capabilities And Experiences
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.
For candidates working in person or remotely in the below location(s), the salary range for this specific position is $57,456 - $98,496.
Locations: California;
Colorado, Illinois, Minnesota, Nevada;
New York;
Washington State.
In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements
#J-18808-Ljbffr
Apply Now