Assesses multiple business and technical factors to identify and evaluate implementation and coding options for specific policies and recommends the optimal approach.
Optimizes enterprise solutions for implementation of policy that balances clinical, coding, systems, cost, and provider relations elements.
Communicates and monitors execution of a value-added approach to policy implementation in collaboration with clinical and operations stakeholders in business units.
Supports the enterprise medical policy and clinical UM guideline development/review process through creation and maintenance of the Coding section within documents.
Provides support to the Medical Policy Research team.
Develops quality assurance processes to assure accurate code assignment on policies and translation within adjudication systems.
Compiles and classifies quarterly coding updates from CMS and the AMA; communicates coding updates related to MPTAC decisions through department tools and communications.
Provides coding analysis and responds to coding inquiries for internal business partners, including coverage of a shared mailbox.
Manages materials for weekly Coding & Implementation meetings; facilitates meetings as needed.
Assists in the maintenance of the department Document Management System (DMS), including code entry, QA processes, and report releases.
Improvises processes, tools, and measures that standardize and improve performance related to implementation and demonstrate quantifiable value to business units.
Leads the work group and facilitates identification and resolution of local implementation issues.
Completes other duties as assigned.
Minimum Requirements
Requires a BA/BS degree and a minimum of 5 years of related medical policy experience including prior experience leading large, multi-stakeholder regional or enterprise projects; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences
Certified Professional Coder (CPC) strongly preferred.
Experienced reviewing clinical criteria and assign codes according to coding guidance highly preferred.
For candidates working in person or virtually in the below locations, the salary* range for this specific position is $78,800 to $135,929
Location: California, Maine, Nevada and Virginia.
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). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Job Level
Non-Management Exempt
Workshift
Job Family
MED > Medical Ops & Support (Non-Licensed)
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. 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.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.
