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Risk Adjustment Strategic Manager
Elevance HealthRisk 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
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
risk adjustmentcodingMedicare AdvantageMedicaidACA CommercialClinical Documentation Improvementmedical coding practicesdata reportinganalytical skills
Soft Skills
collaborationinfluencerelationship buildingoversightstrategic execution
Tools & Technologies
Microsoft ExcelTableau
Certifications & Qualifications
CPCCRCCCSRHITRHIA
Industry Keywords
managed careCMS auditvalue-based careprovider reimbursement modelspayer side of health insurance
Tech Stack
Tools & technologiesTableau
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