Location: This is a hybrid position (1- 2 day per week in office) and you must be within 50 miles of an eligible Elevance Health Pulse Point location.

The Medicare Risk & Adjustment Coding Lead is responsible for leading a team of coders in the identification, collection and assessment of claim/encounter information as it pertains to CMS guidelines.

How you will make an impact:

• Leads Risk Adjustment operations including provider education, data analysis, audits and overseeing record request process.
• Oversees day to day operations. Ensures compliance with mandated and corporate policies.

Minimum Requirements:

• Requires BA/BS in health care or business and minimum of 2 years’ experience in healthcare industry and expertise in Risk Adjustment; or any combination of education and experience, which would provide an equivalent background.
• AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management Association) coding certification or equivalent certification required.
• May travel to worksite and other locations as necessary.

Preferred Skills, Capabilities and Experiences:

• Medicare, Medicaid and commercial business experience preferred.
• We are seeking someone with a collaborative nature and great communication skills.
• Having the adaptability to seamlessly navigate and shift across various business functions as needed.

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.