Senior Payment Integrity Data Consultant

Anticipated End Date:

2026-06-19

Position Title:

Senior Payment Integrity Data Consultant

Job Description:

Senior Payment Integrity Data Consultant

Location: 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. 

The Senior Payment Integrity Data Consultant (Business Information Developer Consultant Senior) is viewed as an expert in the development and execution of data mining analyses.  This position is focused on spending time thinking about programming and how it would be used to design solutions.  

How You Will Make an Impact:  

• Undertakes complex assignments requiring additional specialized technical knowledge.  
• Develops very complex and varied strategic report applications from a Data Warehouse.  
• Establishes and communicates common goals and direction for the team.  
• Establishes and maintains advanced knowledge of data warehouse database design, data definitions, system capabilities, and data integrity issues.  
• Acts as a source of direction, training and guidance for less experienced staff.  
• Monitors project schedules and costs for own and other projects.  
• Develops and supports very complex Data Warehouse-related applications for business areas requiring design and implementation of database tables.  
• Conducts training on the use of applications developed.  

Minimum Requirements: 

• Requires a BS/BA degree; minimum of 6 years experience; or any combination of education and experience, which would provide an equivalent background.  

Preferred Skills, Capabilities, and Experiences: 

• Expert level PC, spreadsheet, and database skills, as well as experience in standard Business Information tools and programming/query languages.  
• The ability to communicate effectively with multiple levels within the organization is strongly preferred. 
• 5+ years of claims editing experience with healthcare payers and/or claims editing software vendors, strongly preferred. 
• Billing, coding, revenue cycle, and claims editing software experience, required. 
• Nationally recognized coding or billing credential preferred: CCS, CCS-P, CPC, CPB, CIC. 
• Experience in claims adjudication and application of NCCI editing and claims payment rules. 
• Ability to interpret claim edit rules and references. 
• Ability to apply industry coding guidelines to claim processes. 
• Proven experience reviewing, analyzing, and researching coding issues for payment integrity. 
• Logic skills: ability to break policy edits down into decision making paths. 
• Ability to troubleshoot and apply root-cause analysis of logics not functioning as intended. 
• Strong ideation skills. 

Job Level:

Non-Management Exempt

Workshift:

1st Shift (United States of America)

Job Family:

RDA > Business/Health Info

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 agr