Risk Adjustment Strategic Manager

Elevance Health

Risk Adjustment Strategic Manager overseeing day-to-day operations for risk adjustment programs at Elevance Health. Responsible for driving operational excellence and compliance with CMS requirements.

Posted 6/10/2026full-timeConnecticut, Kentucky, Maine, New Jersey, New York, Tennessee, Virginia • 🇺🇸 United StatesMid-LevelSenior💰 $102,960 - $185,328 per yearWebsite

Tech Stack

Tools & technologies

Tableau

About the role

Key responsibilities & impact

Oversee day-to-day operations and strategic execution of enterprise risk adjustment programs
Assist management overseeing risk adjustment programs including claims, vendor quality, and audits
Develop metrics, policies, and procedures for validation of programs return on investment
Collaborate with operations risk and compliance teams for implementing initiatives
Provide oversight and ensures accurate coding for Medical Revenue Management programs
Serve as a subject matter expert on coding
Work collaboratively with Enterprise Risk Adjustment team, Business Operations, Regulatory Compliance, and Internal Audit
Influence others and work effectively to develop relationships with stakeholders

Requirements

What you’ll need

Requires a BA/BS in related field
Minimum of 5 years experience in managed care setting
Extensive risk adjustment experience
Experience with CMS audit
Coding knowledge strongly preferred
MBA or MHA in Healthcare Administration preferred
Experience working on payer side of health insurance industry preferred
Strong understanding of risk adjustment models including: Medicare Advantage, Medicaid, ACA Commercial preferred
Knowledge of value-based care providers and provider reimbursement models preferred
Experience working directly with providers and/or provider group leadership preferred
Preferred background in Clinical Documentation Improvement (CDI) and medical coding practices
Certified coder credential preferred (e.g. CPC, CRC, CCS, RHIT, RHIA)
Moderate to advanced proficiency in Microsoft Excel, Tableau, or other data reporting and analytical tools preferred.

Benefits

Comp & perks

Health insurance
401(k) matching
Paid time off
Remote work options
Incentive and recognition programs
Equity stock purchase program

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

risk adjustmentcodingMedicare AdvantageMedicaidACA CommercialClinical Documentation Improvementmedical coding practicesdata reportinganalytical skills

Soft Skills

collaborationinfluencerelationship buildingoversightstrategic execution

Certifications

CPCCRCCCSRHITRHIA