Contract Rhia Jobs in Indiana (NOW HIRING)

Virtual: This role enables associates to work virtually full-time, with the exception of required in‑person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work‑life integration, and ensures essential face‑to‑face onboarding and skill development.

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.

• Conducts pre‑certification, retrospective, out‑of‑network and appropriateness‑of‑care reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
• Ensures member access to medically necessary, quality healthcare in a cost‑effective setting according to contract.
• Consults with clinical reviewers and/or medical directors to ensure medically appropriate, high‑quality, cost‑effective care throughout the medical management process.
• Collaborates with providers to assess member needs for early identification of and proactive planning for discharge planning.
• Facilitates member care transition through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and does not issue non‑certifications.
• Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
• Serves as the team lead and responds to the most complex medical issues.
• Ensures consistency in benefit application.
• May lead cross‑functional teams, projects, initiatives, process‑improvement activities, and requires previous managed care experience.
• May serve as departmental liaison to other areas of the business unit or as representative on enterprise initiatives.

• Requires AS in nursing and minimum of 7 years of acute care clinical experience; or any combination of education and experience which provides an equivalent background.
• Prior managed care experience required.
• Current unrestricted RN license in applicable state(s) required.

• Certifications: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Improvement Practitioner (CDIP), Certified Professional Coder (CPC) or Inpatient Coding Credential such as CCS or CIC.
• Experience with third‑party DRG Coding and/or Clinical Validation Audits or hospital clinical documentation improvement experience preferred.
• Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing guidelines, payer reimbursement policies, and coding terminology preferred.
• Lead experience preferred.

Salary range: $89,520 to $161,136. Locations: California; Colorado, Illinois, Maryland, Minnesota, Nevada; New York; Washington State.

Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws.