Reimbursement Implementation Specialist II

Reimbursement Implementation Specialist II

Location: Hybrid1: This role requires associates be in the office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Reimburse Implement Specialist II provides accurate, timely maintenance of complex provider and reimbursement information.

How you will make an impact:

• Synchronizes data on claims and provider databases and provides expertise on business requirements for multiple business regions.
• Identifies, analyzes, and resolves issues for multiple system provider databases.
• Participates in system testing and analysis in support of new functionality, new system processes, and business rules changes.
• Validates the data to be housed on provider databases and ensures adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing.
• Researches and resolves complex exceptions and error reports.
• Determines regional/cap/business indicators for multiple business areas to assure accurate reimbursement based on provider contract and area fee schedules.
• Determines training needs and provides training to less experienced associates and outside customers on multiple provider data base systems and with multiple business requirements.

Minimum Requirements:

• Requires a H.S. diploma or equivalent and a minimum of 3 years provider database experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Claims support experience strongly preferred.
• Maryland Medicaid or Public Sector Medicaid account knowledge strongly preferred.
• Intermediate to Advanced Microsoft Excel experience preferred.

Job Level: Non-Management Non-Exempt

Workshift: Varies

Job Family: PND > Pricing Configuration

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 may contact elevancehealthjobssupport@elevancehealth.com for assistance.