FAQs
What is the role of the Provider Reimbursement Administrator in Carelon Payment Integrity?
The Provider Reimbursement Administrator ensures accurate adjudication of claims by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
Are there specific qualifications required for this position?
Yes, a BA/BS degree is required along with a minimum of 2 years of related experience, or an equivalent combination of education and experience.
Is specialized nursing knowledge preferred for this role?
Yes, having an active Registered Nurse license is strongly preferred for this position.
What skills are considered advantageous for applicants?
Proficiency in Excel and analytics, the ability to manipulate data files, and coding certification are highly desirable skills.
Where can candidates work for this position?
The ideal candidate should live within 50 miles of one of the pulse point locations and will work on a hybrid model, which includes 1-2 days per week in the office.
What is the salary range for this position?
The salary range for this role is $57,456 to $98,496, depending on various factors such as geographic location, work experience, education, and skill level.
What benefits does Elevance Health provide?
Elevance Health offers a comprehensive benefits package, including incentive and recognition programs, equity stock purchase options, and 401k contributions, among other benefits subject to eligibility requirements.
How does Elevance Health ensure equal pay opportunities?
Elevance Health is committed to ensuring equal pay opportunities for equal work, adhering to all federal, state, and local pay equity laws.
What responsibilities does this role include regarding coding and fee schedules?
The role includes performing CPT/HCPCS code and fee schedule updates, analyzing coverage and reimbursement implications, and preparing correspondence to providers about coding and fee schedule changes.
Will training be provided for customer service staff?
Yes, the Provider Reimbursement Administrator will train customer service staff on system issues related to reimbursement and claims adjudication.