Digital Content Strategy Mgr (US)
Elevance Health

The Digital Content Strategy Mgr will be responsible for driving the development and execution of the clinical content scope in alignment with the product and content strategy to meet financial and operational targets. As a Digital Content Strategy Mgr, you'll research and interpret CMS, CPT/AMA and other major payer policies based on healthcare correct coding and regulatory requirements. You'll identify common error areas that can be made into automated software logic that prevent overpayments from occurring. You'll take your edits from concept to specification and then through review, testing and finally data validation. Your goal is to develop claims editing logic and content that promote payment accuracy and transparency across Medicaid, Medicare, and Commercial lines of business.

How you will make an impact:

• Oversee the conception and development of new content.
• Provides data-based reports and recommendations to optimize content performance and guide content strategy.
• Review healthcare policy (Medicaid manuals, fee schedules, CCI, OIG Alerts, LCAs/LCDs, NCDs, Medicare manuals, etc.) for coding and billing guidelines that can be turned into software editing rules.
• Create billing edits that provide clients with monetary savings and promote coding accuracy.
• Use structural design to turn policy language into specifications that developers turn into software coding edits or logic.
• Build unit tests to verify the functionality of the edits.
• Apply revenue cycle, coding, and billing expertise to interpret policy based on correct coding, billing, and auditing guidelines.
• Provide in-depth research on regulations and support edits with official documents.
• Validate if edits are working as intended and support decisions with validation data.
• Analytical and able to present to business partners (internal/external) to demonstrate the content value.
• Maintain current industry knowledge of claim edit references including, but not limited to: AMA, CMS, NCCI.
• Collaborate with the Content and Engineering & Data teams to develop, adjust, and validate edits.
• Independently meet weekly productivity and quality goals.
• Curates source content.
• May develop and maintain the content plan, own and manage content maintenance plan to ensure content supports strategy.
• Contributes to a core center of excellence for digital editing content.

Minimum Requirements:

Requires a BA/BS in a related field and a minimum of 5 years of related experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Masters and Scaled Agile Framework Training 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, strongly preferred.
• Nationally recognized coding or billing credential required: CCS, CCS-P, CPC, CPB.
• Experience in claims adjudication and application of NCCI editing and claims payment rules.
• Ability to interpret claim edit rules and references.
• Solid understanding of claims workflow including the interconnection with claim forms
• 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.
• Intermediate level proficiency in Excel (ability to manipulate data using excel functions along with pivot tables, v-look up, etc).
• SQL query-building and lookup skills.

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