Anthem, Inc. Risk Adjustment Strategic Manager in Indianapolis, Indiana
SHIFT: Day Job
Be a Part of an Extraordinary Team!
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
Risk Adjustment Strategic Manager
Location: Remote opportunity-OH, IN, KY and TN preferred. Other locations may be considered.
As a Risk Adjustment Strategic Manager for Anthem, you will be responsible for serving as a strategic partner for the Medicare business to Enterprise Risk Adjustment, Business Operations, Regulatory Compliance and Internal Audit business units. Identifies trends and strategizes how the business can be more efficient and effective in the market. Utilizes trend data to provide more strategic direction to providers.
How you will make an impact:
Assists management by overseeing day to day operations for risk adjustment programs including both prospective and retrospective, claims, vendor quality, and audits.
Develops metrics, policies, and procedures in support of required deliverables and validation of programs return on investment while ensuring the programs are in compliance with Center for Medicare and Medicaid Services (CMS) program requirements.
Serves as a strategic partner to the business and contributes to ideas and solutions.
Influences others and works effectively to establish and develop working relationships both internally and externally with business stakeholders.
Obtains and complies trend data and educates providers.
Collaborates with the operations risk and compliance teams in implementing and deploying Enterprise Risk and Compliance initiatives, processes, and tools.
Effectively drives remediation of risks and issues by collaborating with Business Operations, Internal Audit and Regulatory Compliance.
Finds root cause and recommends innovative solutions.
Provides oversight and ensures complete and accurate coding for Medical Revenue Management programs driving the revenue we receive from CMS.
Serves as a subject matter expert on coding.
Leads and consults with operations on ad hoc requests/special projects.
Works collaboratively with Enterprise Risk Adjustment team, Business Operations, Regulatory Compliance, and Internal Audit.
Requires a BA/BS in a related field and minimum of 5 years of experience in a managed care setting with extensive risk adjustment experience with a focus on CMS audit experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Qualifications:
Project Management experience
Matrix organization experience
Coding knowledge strongly preferred
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.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.
Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem 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 email@example.com for assistance.