Responsible for evaluating physician and hospital medical records and medical assessment forms to ensure compliance with federal guidelines and medical documentation requirements.
How you will make an impact:
- Serves as final arbiter regarding the Risk & Recovery’s Retrospective Risk Adjustment (RA) Coding Team.
- Identifies training opportunities for internal and external stakeholders related to federal guidelines, best practices, and medical record documentation requirements.
- Collects and analyzes data to formulate recommendations and solutions based on trends and results.
- Provides feedback to Risk & Recovery leadership on performance improvement opportunities as a result of performance gaps.
- Acts as a subject matter expert to internal and external stakeholders in the area of federal requirements and best practices.
- Participates in and represents the department in business leadership groups, including external professional groups specializing in coding and provider education.
- Assists the business with research and documentation of workflows and policies and procedures.
- Requires BA/BS in health sciences, health management, or nursing and minimum of 5 years of ICD-9 coding or medical record review experience in a consultative role; or any combination of education and experience, which would provide an equivalent background.
- CPC from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) and CPMA (Medical Auditing Certification) from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) or equivalent certification required.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
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 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 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.ElevanceHealthinc.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@example.com for assistance.