Job Information
Elevance Health Risk Adjustment Strategic Manager in Richmond, Virginia
Location: Indianapolis IN, Mason OH, Tampa FL, Atlanta GA, Richmond VA
Hours: Monday - Friday
Travel: Hybrid (1-2 days onsite per week)
Position Overview:
Responsible for serving as a strategic partner for the Medicare business to Enterprise Risk Adjustment, Business Operations, Regulatory Compliance and Internal Audit business units. Identifies trends and strategizes how the business can be more efficient and effective in the market. Utilizes trend data to provide more strategic direction to providers.
How You Will Make an Impact:
Assists management by overseeing day to day operations for risk adjustment programs including both prospective and retrospective, claims, vendor quality, and audits
Develops metrics, policies, and procedures in support of required deliverables and validation of programs return on investment while ensuring the programs are in compliance with Center for Medicare and Medicaid Services (CMS) program requirements
Serves as a strategic partner to the business and contributes to ideas and solutions
Influences others and works effectively to establish and develop working relationships both internally and externally with business stakeholders
Obtains and complies trend data and educates providers
Collaborates with the operations risk and compliance teams in implementing and deploying Enterprise Risk and Compliance initiatives, processes, and tools
Effectively drives remediation of risks and issues by collaborating with Business Operations, Internal Audit and Regulatory Compliance
Finds toot cause and recommends innovative solutions
Provides oversight and ensures complete and accurate coding for Medical Revenue Management programs driving the revenue we receive from CMS
Leads and consults with operations on ad hoc requests/special projects
Works collaboratively with Enterprise Risk Adjustment team, Business Operations, Regulatory Compliance, and Internal Audit
Required Qualifications:
- Requires a BA/BS in a related field and minimum of 5 years of experience in a managed care setting with extensive risk adjustment experience with a focus on CMS audit experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications:
MBA/MHA in Healthcare Administration Preferred
Experience working with Health Insurance payer side of business strongly preferred
Strong understanding of Health insurance Claims processing preferred
Experience working directly with providers and or provider group leadership strongly preferred
Executive Communication skills is a must
Moderate to advanced experience in Excel and Tableau preferred
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 agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), 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. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.