Elevance Health · 4 hours ago
Provider Reimburse Admin Sr
Norfolk, VA
Full-time
Hybrid
Mid, Senior Level
4+ years expElevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. The Provider Reimburse Admin Sr ensures accurate adjudication of claims by translating provider contracts and reimbursement policies into effective reimbursement configuration.
Health CareHealth InsurancePersonal HealthWellness
Responsibilities
Reviewing provider contracts to ensure compliance is being maintained by adhering to SOX controls, State mandates, and CMS guidelines
Analyzing new provider contracts for coverage, policy, reimbursement development, and implications for system edits
Configuring complex pricing and new reimbursement methodologies for physician, facility, and ancillary contracts
Configuring, maintaining, and troubleshooting DOFR tables within Facets to ensure accurate financial responsibility across PCPs, IPAs, and delegated entities
Responding to system inquiries and appeals-- primarily in order to troubleshoot claims adjudication issues related to configuration
Creating test claims and performing reviews of claims to ensure proper configuration
Conducting research of claims and system edits to identify issues
Leading projects related to provider reimbursement and automation initiatives
Serving as a mentor to less experienced administrators
Working with other departments to resolve system issues
Working with provider contracting staff regarding new and/or modified reimbursement contracts
Assisting with the analysis, documentation, configuration, and testing of current and future markets business requirements
Supporting the upgrade of test environments
Qualification
Required
Requires a BA/BS degree and a minimum of 4 years related experience; or any combination of education and experience, which would provide an equivalent background
Preferred
Experience with FACETS NetworX configuration a MUST
DOFR (division of financial responsibility) Table Configuration strongly preferred
Claims and billing experience strongly preferred
Physician and facility pricing configuration experience strongly preferred
Experience running Microsoft Access queries in relation to FACETS tables (Microsoft Access, TOAD, Oracle) strongly preferred
Experience with Rate Manager; including configuration of custom records preferred
Must know how to read and analyze a contract (physician, ancillary and hospital)
Able to implement PCAs and load fee schedules
Able to use full range of Microsoft Office products proficiently
Experience leading or taking a primary role in the configuration of enterprise-class information systems/ software products in a highly regulated business environment preferred
Medicaid and Medicare experience strongly preferred
Knowledge of CPT/HCPCS coding preferred
Experience working with the implementation of new business in a health insurance industry setting
Benefits
Merit increases
Paid holidays
Paid Time Off
Incentive bonus programs
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
Elevance Health is an integrated whole-health approach to help people in health journey and address their full range of needs.
10001+ employees
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)
Funding
Current Stage
Public CompanyTotal Funding
unknown2001-10-30IPO
Leadership Team
Gail K. Boudreaux
President and CEO
Geeta Wilson
Chief Technology Officer (CTO): Digital Health and Service Experience Platforms
Recent News
2026-01-25
Company data provided by crunchbase