What are the responsibilities and job description for the Manager III Financial Ops Dept position at Elevance Health?
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.
Hybrid Workplace Strategy: 1-2 days in office per week
Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.
The Manager III Financial Ops Dept is responsible for coordinating, directing, and managing several units of varying complexity that has multi-state or multi-functional impact within Cost Containment. Manages the daily operations of a datamining team focused on identifying and recovering overpaid medical claims and maintaining and strengthening the relationship with datamining vendors. The areas of focus for the team this role will be leading include but are not limited to: claim coding and billing, medical terminology, claims payment and recovery process, system configuration, and claims auditing.
How You Will Make An Impact
Requires minimum of 7 years experience with operations, financial reporting and analysis, audit guidelines, budgeting and multi-state operations and processes and minimum of 5 years management experience; or any combination of education and experience which would provide an equivalent background
Preferred Skills And Abilities
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 and Influenza. 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.
Hybrid Workplace Strategy: 1-2 days in office per week
Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.
The Manager III Financial Ops Dept is responsible for coordinating, directing, and managing several units of varying complexity that has multi-state or multi-functional impact within Cost Containment. Manages the daily operations of a datamining team focused on identifying and recovering overpaid medical claims and maintaining and strengthening the relationship with datamining vendors. The areas of focus for the team this role will be leading include but are not limited to: claim coding and billing, medical terminology, claims payment and recovery process, system configuration, and claims auditing.
How You Will Make An Impact
- Assists in the development and implementation of vision, strategies, and tactics to maximize the departments effectiveness while minimizing costs.
- Reviews statistical data of various systems in order to verify accuracy and timely processing.
- Ensures internal controls are appropriate and develops policies and procedures and ensures compliance with government regulations.
- Provides counsel to senior management.
- Works with other areas for solutions to complex problems and participates in critical interactions with both internal and external customers.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires minimum of 7 years experience with operations, financial reporting and analysis, audit guidelines, budgeting and multi-state operations and processes and minimum of 5 years management experience; or any combination of education and experience which would provide an equivalent background
Preferred Skills And Abilities
- Knowledge of claims processing, reimbursement policies and provider contracting
- Ability to lead a high performing team by mentoring and developing associates
- Strong understanding of healthcare industry process
- Commercial experience
- Cost Containment/payment integrity experience
- Experience recovering overpaid Commercial claims
- Vendor management experience
- Experience with complex business environments including multiple entity and highly automated situations
- PMP certification
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 and Influenza. 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.
