Staff VP Prospective Risk Adjustment

Anticipated End Date:

2024-03-25

Position Title:

Staff VP Prospective Risk Adjustment

Job Description:

Staff VP Prospective Risk Adjustment

Location: Elevance Health supports a hybrid workplace model (virtual and in-office) with PulsePoint sites used for collaboration, community, and connection. This leadership role will take part in the hybrid workforce strategy which includes virtual work and in office days 3 or more times per week. May be located within 50-miles or less to any Elevance Health PulsePoint office.

Summary

Accountable for Elevance Health's Prospective Risk Adjustment strategy, performance, and results with enterprise oversight of programs.

Position Responsibilities

• Instill governance to ensure complete and accurate diagnosis codes are identified and submitted to CMS for all members for risk adjusted payment.
• Ensure timely, accurate, and complete submission of risk adjustment data to CMS and reconciliation of plan payments.
• Oversee internal and vendor processes, controls, and reporting to ensure effective processes are in place throughout the organization.
• Develop, execute, and continually refine a quality assurance program to monitor, audit, and improve the quality of provider medical record documentation, diagnosis coding, and the coding work of internal staff and contracted vendors.
• In collaboration with regional and local Medicare health plan leaders, develop and execute strategies, prospective programs, and plans to engage providers in proper assessment, coding, and documentation of all members' conditions.
• Implement governance to improve quality, accuracy, and identification of member health conditions.
• Leverage predictive analytics and other insights from Data Science and Analytics teams to identify opportunities and develop innovative interventions to improve care management.
• Stay informed about CMS, industry trends, and best practices, and utilize this knowledge to refine and advance risk adjustment programs.

Position requirements

At least 10 years Medicare or relevant healthcare work experience, including 8 or more years with risk adjustment and proven leadership experience in healthcare overseeing quality, risk adjustment, or compliance. BS in a Healthcare Economics, Business Administration or an equivalent combination of education and work-related experience.

Preferred Skills, Capabilities and Experiences

• Prior Medicare Risk Adjustment with a focus in Prospective Risk Adjustment strongly preferred.
• Experience with healthcare economics and/or risk adjustment; CPC or CCS-P certification a plus.
• Process improvement knowledge and experience.
• Comprehensive knowledge of payer environment and healthcare systems.
• Strong financial management, organizational, negotiation, analytic and management skills.
• Demonstrated track record of driving large-scale business change, particularly in a matrix environment.
• Masters preferred.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $176,560.00 to $317,808.00

Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

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 conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $176,560.00 to $317,808.00

Locations: California; Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ

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 conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Job Level:

Staff/Regional VP

Workshift:

Job Family:

BSP > Business Support

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. 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 [email protected] for assistance.