Implement & Coding Consultant

Location/Hybrid 1 :
This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

This position will work an 8-hour from shift 8:00 am - 5:00 pm (EST) Monday to Friday. Additional hours may be necessary based on company needs.

The Implement & Coding Consultant is responsible for leading the development, implementation, and evaluation of Corporate Medical Policy coding strategies across the enterprise

Primary duties may include, but are not limited to:

• Conceptualizes implementation approaches that consider both broad business issues/objectives across regions and detailed considerations of adjudication systems, benefit design, and regulatory environments that vary by region.

• Assesses multiple business and technical factors to identify and evaluate implementation and coding options for specific policies and recommends the optimal approach.

• Optimizes enterprise solutions for implementation of policy that balances clinical, coding, systems, cost, and provider relations elements.

• Communicates and monitors execution of a value-added approach to policy implementation in collaboration with clinical and operations stakeholders in business units.

• Supports the enterprise medical policy and clinical UM guideline development/review process through creation and maintenance of the Coding section within documents.

• Provides support to the Medical Policy Research team.

• Develops quality assurance processes to assure accurate code assignment on policies and translation within adjudication systems.

• Compiles and classifies quarterly coding updates from CMS and the AMA; communicates coding updates related to MPTAC decisions through department tools and communications.

• Provides coding analysis and responds to coding inquiries for internal business partners, including coverage of a shared mailbox.

• Manages materials for weekly Coding & Implementation meetings; facilitates meetings as needed.

• Assists in the maintenance of the department Document Management System (DMS), including code entry, QA processes, and report releases.

• Improvises processes, tools, and measures that standardize and improve performance related to implementation and demonstrate quantifiable value to business units.

• Leads the work group and facilitates identification and resolution of local implementation issues.

• Completes other duties as assigned.

• Requires a BA/BS degree and a minimum of 5 years of related medical policy experience including prior experience leading large, multi-stakeholder regional or enterprise projects; or any combination of education and experience which would provide an equivalent background.

• Certified Professional Coder (CPC) strongly preferred.
• Experienced reviewing clinical criteria and assign codes according to coding guidance highly preferred.

For candidates working in person or virtually in the below locations, the salary
* range for this specific position is $78,800 to $135,929

California, Maine, Nevada and Virginia.

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…