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　　Director, Payment Integrity Home/Host Reimbursements

　　Job Family: Finance and Actuarial

　　Type: Full time

　　Date Posted:Jan 19, 2024

　　Anticipated End Date:Feb 29, 2024

　　Reference: JR102504

　　Location:

　　VA, NORFOLK

　　CA, WOODLAND HILLS

　　FL, MIAMI

　　NJ, MORRISTOWN

　　WI, Waukesha

　　GA, ATLANTA

　　IN, INDIANAPOLIS

　　OH, CINCINNATI

　　CA, WALNUT CREEK

　　KY, LOUISVILLE

　　NY, NEW YORK

　　WA, SEATTLE

　　NH, MANCHESTER

　　TX, GRAND PRAIRIE

　　IL, CHICAGO

　　TN, NASHVILLE

　　NY, MIDDLETOWN

　　LA, METAIRIE

　　MN, GILBERT

　　DC, WASHINGTON

　　NV, LAS VEGAS

　　MN, MENDOTA HEIGHTS

　　CA, COSTA MESA

　　MO, ST LOUIS

　　CT, WALLINGFORD

　　NC, CARY

　　MD, HANOVER

　　NJ, ISELIN

　　WV, CHARLESTON

　　DE, WILMINGTON

　　OH, MASON

　　OH, SEVEN HILLS

　　RI, SMITHFIELD

　　CO, DENVER

　　NV, LAS VEGAS

　　CA, PALO ALTO

　　NC, WINSTON

　　ME, SOUTH PORTLAND

　　GA, ATLANTA

　　NY, LATHAM

　　OH, COLUMBUS

　　VA, RICHMOND

　　TX, HOUSTON

　　MI, DEARBORN

　　IA, W DES MOINES

　　VA, ROANOKE

　　MA, WOBURN

　　FL, TAMPA

　　Description

　　Elevance Health's Payment Integrity organization is determined to recover, eliminate and prevent unnecessary medical-expense spending. This team is looking to hire a Director of Payment Integrity Home/Host Reimbursement Operations. This People leader will oversee a team that is responsible for coordinating, directing, and managing invoicing operations for payment integrity savings related to Blues ITS claims, owning the home/host reimbursement and reconciliation operation. S/he will lead and participate in the external facing Blue (BCBS) Payment Integrity Committee and related workgroups, and also act as project sponsor for department projects.

　　How you will make an impact:

　　Counsels senior management on BCBSA policies related to payment integrity.

　　Develops and implements vision, strategies, and tactics to maximize the departments effectiveness while minimizing costs.

　　Ensures internal controls are appropriate and develops policies and procedures and ensures compliance with BCBSA and related government regulations.

　　Works with other areas for solutions to complex problems and provides guidance to internal and external customers related to payment integrity invoicing operations and BCBSA policy impacts.

　　Hires, trains, coaches, counsels, and evaluates performance of direct reports.

　　Requires minimum of 8 years experience with operations, financial reporting and analysis, audit guidelines, budgeting and multi-state operations and processes and a minimum of 5 years management experience; or any combination of education and experience which would provide an equivalent background.

　　Preferred skills and experiences:

　　-Strong background in Health Plan Payment Integrity operations

　　-Expertise in the Blues (BCBS) Plan/ Interplan home/host reimbursement and reconciliation operations

　　-Experience with ITS system, claims, reimbursements, invoicing and reconciliations

　　-Former People leadership experience

　　For candidates working in person or remotely in the below locations, the salary* range for this specific position is $127,680 to $229,824

　　Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

　　In 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 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 [email protected] for assistance.

　　EEO is the Law

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　　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 ([email protected])