Job Description
WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online application for consideration of employment for any position. We will never ask you for a credit card, send you a check, or ask you for payment as part of consideration for employment.
Dir Provider Education and Coding
- Job Family: Customer Care
- Type: Full time
- Date Posted:Feb 14, 2024
- Anticipated End Date:Apr 26, 2024
- Reference: JR106144
Location:
- IN, INDIANAPOLIS
- Virginia, Roanoke
Description
Location: This position can be located within 50 miles of any PulsePoint.
Responsible for leading the Medicaid, Medicare and Commercial Risk Coding and Education enterprise organization. Has oversight for these lines of business with responsibilities for strategy development, implementation, and management of risk adjustment coding, vendor management, and enterprise wide network provider education program across all 3 markets.
Primary duties may include, but not limited to:
- Develops and implements strategic goals related to risk revenue and quality initiatives across the Medicaid, Medicare and Commercial lines of business.
- Leads the design, implementation, and measurement of risk adjustment programs.
- Directs provider education program to drive integration of new opportunities that impact quality clinical programs and whole population health.
- Initiates relationships and joint planning activities with strategic cross-matrix business owners to understand the business direction and risk score movement.
- Responds to RFPs for internal and external business clients and supports the rebid process through strategic development of state required network education.
- Assists with analytics and development of quality measures for new payment models (value-based/risk-based payment structures.
- Provides clinical coding oversight, industry level expertise, and leadership to ensure the delivery comprehensive programs that support Medicaid VBP, PQIP, STARS, HEDIS, URAC, and NCQA accreditations.
- Hires, trains, coaches, counsels, and evaluates performance of associates.
Minimum Requirements:
- Requires B.A. or B.S. degree; and a minimum of 7 years related experience, including prior leadership/management experience; or any combination of education and experience which would provide an equivalent background.
- CPC or CCS from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) or equivalent certification required.
Preferred skills, qualifications and experiences:
- Internal, public audit, quality assurance and project management experience preferred.
- MBA preferred.
- Expertise in Medicare coding is strongly preferred.
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.com for assistance.
EEO is the Law
Equal Opportunity Employer / Disability / Veteran
Please use the links below to review statements of protection from discrimination under Federal law for job applicants and employees.
- EEO Policy Statement
- Know Your Rights
- Pay Transparency
- Privacy Notice for California Residents
Elevance Health, Inc. is anE-verify Employer (https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)
Need Assistance?
Email us (elevancehealthjobssupport@elevancehealth.com)