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Elevance Health · 8 hours ago

Provider Reimburse Admin

Chicago, IL

Contract

Hybrid

Entry, Mid Level

$63K/yr - $94K/yr

2+ years exp

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. The Provider Reimburse Admin will be responsible for accurate translation of provider contracts and policies into effective reimbursement criteria, ensuring accurate adjudication of claims and conducting research to support policy development.

Health CareHealth InsurancePersonal HealthWellness

H1B Sponsor Likely

Responsibilities

Ensures accurate adjudication of claims, by translating provider contracts, medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria

Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducts research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy

Translates provider contracts into reimbursement and operational support rules

Coordinates research and responds to system inquiries

Conducts research of audit systems and system edits to identify claims audit rule inventory for accuracy

Trains staff on system issues and rule creations

Works with provider contracting staff when new/modified reimbursement contracts are needed

Qualification

Provider contracts translationClaims adjudicationMedical policies knowledgeData analysisTraining staffResearch skillsCommunication skillsTeam collaboration

Required

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

Preferred

Knowledge of provider networks, the medical management process, internal business processes, and expertise with internal local technology preferred

Benefits

Comprehensive benefits package

Incentive and recognition programs

Equity stock purchase

401k contribution

Paid Time Off

Medical

Dental

Vision

Short and long term disability benefits

401(k) +match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Company

Elevance Health

Glassdoor3.6

Elevance Health is an integrated whole-health approach to help people in health journey and address their full range of needs.

Founded in 1944

Indianapolis, Indiana, USA

10001+ employees

https://www.elevancehealth.com

H1B Sponsorship

Elevance Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (488)

2024 (604)

2023 (660)

2022 (222)