Staff VP Risk Adjustment

Position Title:

Staff VP Risk Adjustment

Job Description:

Position accountabilities

• Accountable for Elevance Health Medicare Risk Adjustment strategy, performance, and results with enterprise oversight of programs
• 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.
• Develop and implement strategies for effective and regular monitoring and auditing to improve quality and reduce risk stemming from CMS RADV audits.
• Develop and implement programs for provider training and education on HCC risk adjustment, proper medical record documentation and diagnosis coding accuracy.
• In collaboration with regional and local Medicare health plan leaders, develop and execute on 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.
• Develop, lead and refine processes to project, plan, analyze and report on revenue trends for all Medicare Advantage products
• Stay informed about CMS and 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. Masters 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.
• Experience managing advanced analytics.
• Demonstrated track record of driving large-scale business change, particularly in a matrix environment.

Job Level:

Staff/Regional VP

Workshift:

Job Family:

BSP > Business Support

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

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 - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World's Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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.

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 has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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.