Risk Adjustment Compliance Manager
Elevance Health, Indianapolis, IN, United States
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, Mason, OH or Norfolk, VA. 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.
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.
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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, Mason, OH or Norfolk, VA. 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.
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.
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