Risk Adjustment Compliance Manager

Risk Adjustment Compliance Manager

Risk Adjustment Compliance Manager

Location:

This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Ideal candidates will be able to report to one of our Pulse Point locations in Atlanta, GA, Indianapolis, IN or Mason, OH.

Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Risk Adjustment Compliance Manager is responsible for managing foundational and strategic compliance responsibilities with consistent excellence that support the team and management.

How you will make an impact:

• Partner with Encounters SMEs to resolve issues, mitigate risk, and enhance processes.
• Manage and track compliance items in C360.
• Utilize data skills to understand scope/impact of policy/process changes – both proactively and in response to changing regulations and oversight.
• Manage/oversee projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments and audit planning.
• Conduct mock audits and audit training.
• Manage audit evidence preparation.
• Assess audit preparedness.
• Establish project plans, gap analysis, milestone dates, leadership updates and other significant aspects.
• Maintain knowledge of laws, regulations, company strategies to assess impact.
• Consult with clients as subject matter expert.
• Conduct complex investigations, document findings, and ensure corrective actions are made.
• Interface with external clients, regulators, vendors, suppliers, internal stakeholders, and high levels of management.

Minimum Requirements:

Requires a BA/BS and minimum of 6 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• MS/MBA/JD or professional designation preferred.

Job Level: Non-Management Exempt

Workshift:
Job Family: FRD >
Compliance

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.

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.

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.…