Audit & Reimbursement III and Senior

Join Elevance Health as an Audit & Reimbursement III and Senior professional in Penbrook, Dauphin County, where you'll lead healthcare audit initiatives and guide reimbursement accuracy for a dynamic insurance organization. This full-time position offers the opportunity to make a direct impact on claims processes while developing your team.

About the Role

As an Audit & Reimbursement III and Senior at Elevance Health, you'll oversee critical audit and reimbursement functions that ensure accuracy, compliance, and quality across healthcare claims operations. This role combines hands-on expertise in medical claims auditing with senior-level responsibilities, including mentoring, process improvement, and strategic oversight of reimbursement compliance.

What You'll Do

• Conduct comprehensive audits of healthcare claims and reimbursement processes to verify compliance with regulatory requirements and company policies
• Review medical documentation, billing records, and claim submissions for accuracy and appropriate reimbursement determinations
• Identify discrepancies, billing errors, and opportunities for improvement within audit and reimbursement workflows
• Mentor and guide junior audit staff, providing technical expertise and support on complex reimbursement cases
• Develop and implement process improvements to enhance audit efficiency and ensure accuracy across claims operations
• Maintain detailed documentation and reporting on audit findings and corrective actions
• Collaborate with cross-functional teams to resolve billing disputes and ensure policy adherence
• Stay current with healthcare regulations, medical coding standards, and reimbursement policies

What We're Looking For

• Proven experience in healthcare audit, claims processing, or reimbursement management, with demonstrated expertise at a senior level
• Strong knowledge of medical coding, healthcare billing practices, and insurance regulations
• Ability to analyze complex claims data and identify compliance issues with strong attention to detail
• Leadership experience with the ability to mentor and develop team members
• Excellent communication and documentation skills
• Proficiency with healthcare systems, claims management software, and data analysis tools
• Strong organizational skills and ability to manage multiple priorities

About Elevance Health

Elevance Health is a leading health insurance company dedicated to improving healthcare access and outcomes for members. We're committed to creating a collaborative work environment where your expertise contributes directly to our mission of advancing healthcare delivery.

How to Apply

To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.