Risk Adjustment Strategic Manager

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. Alternate locations may be considered if candidates reside within a commuting distance from an office. Salary range for this position is $102,960 to $185,328. Location(s): New York, New Jersey. Key Responsibilities Oversee day-to-day operations for risk adjustment programs including both prospective and retrospective, claims, vendor quality, and audits. Develop metrics, policies, and procedures to support deliverables and validate ROI while ensuring CMS compliance. Serve as a strategic partner to business leadership and contribute ideas and solutions. Influence stakeholders and develop working relationships internally and externally. Obtain and analyze trend data and educate providers. Collaborate with operations risk and compliance teams to implement and deploy initiatives, processes, and tools. Drive remediation of risks and issues in collaboration with Business Operations, Internal Audit, and Regulatory Compliance. Find root causes and recommend innovative solutions. Provide oversight and ensure accurate coding for Medical Revenue Management programs. Serve as a subject matter expert on coding. Lead and consult on ad hoc requests/special projects. Work collaboratively with Enterprise Risk Adjustment team, Business Operations, Regulatory Compliance, and Internal Audit. Oversee daily operations of risk adjustment programs across prospective and retrospective initiatives. Provide oversight of provider engagement, education, data submissions, vendor quality performance, and audit activities. Minimum Qualifications BA/BS in a related field and minimum of 5 years of experience in a managed care setting with extensive risk adjustment experience focusing on CMS audit; or equivalent education and experience. Preferred Skills, Capabilities and Experiences Coding knowledge strongly preferred. MBA or MHA in Healthcare Administration preferred. Experience on the payer side of the health insurance industry. Strong understanding of risk adjustment models (Medicare Advantage, Medicaid, ACA Commercial). Knowledge of value-based care provider reimbursement models. Experience working directly with providers and/or provider group leadership. Background in Clinical Documentation Improvement (CDI) and medical coding practices. Certified coder credential (e.g., CPC, CRC, CCS, RHIT, RHIA). Executive-level communication and presentation skills. Moderate to advanced proficiency in Microsoft Excel, Tableau, or other data reporting and analytical tools. Benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution. 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 may contact View email address on click.appcast.io for assistance. #J-18808-Ljbffr Women Veterans Interactive