Carelon Medical Coding/Auditing Manager - Behavioral Health

Anticipated End Date:

2025-07-08

Position Title:

Carelon Medical Coding/Auditing Manager - Behavioral Health

Job Description:

Carelon Medical Coding/Auditing Manager - Behavioral Health 

Supports Payment Integrity & Behavioral Health

Location: Hybrid 2: This role requires associates to be in-office 3-4 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.

Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.

A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

The Medical Coding/Auditing Manager is responsible for ensuring the accuracy of claims payment through the management of a robust process for prevention, detection, and correction of billing, payment and membership errors. Works with health plan leaders, oversees the monitoring and enforcement of the fraud, waste, and abuse compliance program to prevent and detect potential fraud, waste, and abuse activities pursuant to state and federal rules and regulations.

How you will make an impact:

• Has detailed technical knowledge of claims payment accuracy and participates on cross functional teams focused on problem remediation and long term resolution.

• Anticipates the effect of changes in the business environment on future claim errors.

• Evaluates regulatory compliance and Health Care Reform changes to determine potential impact.

• Evaluates provider activities to assist in the detection of fraud, waste and abuse activities.

• Monitors provisions of the compliance plan, including fraud, waste, and abuse policies and procedures, investigates unusual incidents and implements corrective action plans.

• Develops and analyzes monthly reports.

• Develops project plans and oversees project execution, issue management and progress reporting.

• Develops processes to support early detection of systemic issues causing operational inefficiencies.

Minimum Requirements

• Requires a BA/BS in business, engineering, nursing, finance, or healthcare administration and minimum of 5 years related work experience, including minimum of 2 years leadership experience; or any combination of education and experience, which would provide and equivalent background.

Preferred Skills, Capabilities and Experiences

• MBA preferred.

• 5 years of medical coding/auditing experience preferred.

• Prior Behavioral Health auditing experience preferred.

• CPC is preferred.

• Proficiency with Excel/MS Word preferred.

For candidates working in person or virtually in the below location, the salary* range for this specific position is $ 93,828 to $140,742.

Locations: Maryland.

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 condi