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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.Provider Payment Appeal Analyst II
Job Family: Customer Care
Type: Full time
Date Posted:Feb 08, 2024
Anticipated End Date:Mar 31, 2024
Reference: JR103928
Location:
IN, INDIANAPOLIS
PA, SEVEN FIELDS
VA, ARLINGTON
FL, MIAMI
MA, BOSTON
OH, CINCINNATI
NY, NEW YORK
CT, ROCKY HILL
CA, RANCHO CORDOVA
MI, WIXOM
TN, BRENTWOOD
DC, WASHINGTON
MD, ANNAPOLIS
NV, LAS VEGAS
MN, MENDOTA HEIGHTS
TN, KNOXVILLE
VA, ASHBURN
OH, COLUMBUS
NC, CARY
WA, LAKEWOOD
WI, MADISON
WV, CHARLESTON
NE, LINCOLN
DE, WILMINGTON
NE, OMAHA
OH, SEVEN HILLS
ID, MERIDIAN
ID, MERIDIAN
RI, SMITHFIELD
NC, WINSTON
GA, ATLANTA
DC, WASHINGTON
IL, DEERFIELD
VA, RICHMOND
FL, TAMPA
FL, ALTAMONTE SPRINGS
FL, TALLAHASSEE
KS, TOPEKA
VA, ROANOKE
NY, Lake Success
CO, COLORADO SPRINGS
FL, JACKSONVILLE
CA, WOODLAND HILLS
WI, Waukesha
NJ, MORRISTOWN
MO, JEFFERSON CITY
TN, MEMPHIS
OH, MASON
NY, ALBANY
CA, SACRAMENTO
CA, WALNUT CREEK
PA, HERMITAGE
KY, LOUISVILLE
NH, MANCHESTER
WA, SEATTLE
TX, GRAND PRAIRIE
IL, CHICAGO
TX, AUSTIN
MI, DEARBORN
VA, CHESAPEAKE
TN, NASHVILLE
MN, GILBERT
LA, METAIRIE
NY, MIDDLETOWN
IL, SPRINGFIELD
GA, MIDLAND
TX, HOUSTON
VA, NORFOLK
CA, LOS ANGELES
CT, WALLINGFORD
MO, ST LOUIS
CA, COSTA MESA
MD, HANOVER
NJ, ISELIN
CA, CERRITOS
OH, MASON
IL, CHICAGO
CO, DENVER
NV, LAS VEGAS
CA, PALO ALTO
ME, SOUTH PORTLAND
NY, LATHAM
OH, COLUMBUS
GA, AUGUSTA
IA, W DES MOINES
MA, WOBURN
MA, NEWTON 55 CHAPEL ST
DescriptionProvider Payment Appeal Analyst IILocation: Remote, but must reside within 50 miles of a Pulse point locationHours: An 8 hour shift between the hours of 6 am – 6 pm Training will be 8 am - 4:30 pm ESTThe Provider Payment Appeal Analyst II supports the Payment Dispute process across all lines of business and is specifically responsible for the resolution of Provider Payment Appeal requests.How you will make an impact:
Reviews and analyzes provider requests to investigate the outcome of a Reconsideration.
Considers all information when determining whether to uphold or overturn primary decision.
Works with various departments including Provider Solutions and Health Plan Operations leadership when necessary, to determine root cause and appropriate resolution.
Must work with Claims Operations to remediate impacted claims.
The Analyst II will be responsible to manage Claim Payment Appeal escalations and may serve as a liaison between grievances & appeals and /or medical management, legal, service operations and/or other internal departments as appropriate.
Minimum Requirements:
Requires a HS diploma or GED and a minimum of 4 years of claims research and/or issue resolution or analysis of reimbursement methodologies within the health care industry; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
Experience with multiple lines of business a plus.
Bachelor's degree preferred.
For candidates working in person or remotely in the below locations, the salary range for this specific position is $24.35 to $43.82Locations : California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJIn 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 AreElevance 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 WorkAt 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 LawEqual Opportunity Employer / Disability / VeteranPlease 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)
