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Form of workJob Description
Director, Clinical Content & Edits
Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
The Director, Clinical Content & Edits will be responsible for working with a leader of Digital Payment Accuracy to create and curate healthcare editing content, ensuring that it is accurate, up-to-date, and tailored to support rules engine implementation and claims analysis. This role will act as a subject matter expert for medical claim processing, ensuring that our solutions align with industry best practices, regulatory requirements, and advanced analytics. The person in this role will utilize their unique knowledge and broad expertise of healthcare claims and analytics to drive the development of new editing capabilities.
How you will make an impact:
- Works with both internal and external customers to promote understanding of health services activities and objectives within the company and to prioritize departmental projects according to Carelon corporate, regional, and departmental goals.
- Maintains expert knowledge of current industry standards, quality improvement activities, and strong payment accuracy and analytics skills.
- Utilize your analytical skills to develop actionable insights that drive improved payment accuracy through rules engines, claims analysis and payor specific trend analytics.
- Foster a collaborative and innovative culture within the content team, providing mentorship and support to team members as they contribute to content development and claims analysis efforts.
- Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and 5 years progressively responsible management experience in a health care environment or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
- BS, MS or advanced degree in a health care related field (i.e. Health Information Management, Nursing, Health Education) or business strongly preferred.
- Master's degree and/or RHIA, RHIT, CCS, Business and/or CPC certification preferred.
- Expert knowledge of payer environments and claims management including government and industry standard reimbursement methodologies such as professional fee schedules, OPPS, IPPS, APCs, strongly preferred.
- Expert coding knowledge of HCPCS/CPT and ICD-10-CM coding, strongly preferred.
- Previous experience working at a payment accuracy vendor leading content development and/or claims analytics teams is preferred.
- Thorough knowledge of CPT, ICD-10, and HCPCS coding guidelines, as well as medical terminology, anatomy, and physiology.
- Solid understanding of claims workflow including the interconnection with claim forms.
- Ability to apply industry coding guidelines to claim processes.
- Proven experience reviewing, analyzing, and researching coding issues for payment integrity.
Locations: California, Colorado, New Jersey (Jersey City Only), New York
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 considered to be 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.
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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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. 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 may contact elevancehealthjobssupport@elevancehealth.comfor assistance.
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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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. 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 may contact elevancehealthjobssupport@elevancehealth.comfor assistance.
