Anticipated End Date:

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Job Description:

Location: St Louis MO, Atlanta GA, Mason OH, Tampa FL, Grand Prairie TX, Overland park KS, Indianapolis IN

Hours: Standard Working hours

Travel: This role requires associates to be in-office 1 - 2 days 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. 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.

Position Overview:

Provides oversight of medical record coding and documentation review activities to support compliance with federal requirements and medical documentation standards. Delivers audit findings and insights to healthcare providers and stakeholders, while supporting provider education initiatives focused on Medicare risk adjustment coding accuracy, documentation quality, and regulatory compliance.

How You Will Make an Impact:

• Serves as final arbiter regarding the Risk & Recovery’s Retrospective Risk Adjustment (RA) Coding Team.

• Identifies training opportunities for internal and external stakeholders related to federal guidelines, best practices, and medical record documentation requirements

• Collects and analyzes data to formulate recommendations and solutions based on trends and results

• Provides feedback to Risk & Recovery leadership on performance improvement opportunities as a result of performance gaps

• Acts as a subject matter expert to internal and external stakeholders in the area of federal requirements and best practices

• Participates in and represents the department in business leadership groups, including external professional groups specializing in coding and provider education

• Assists the business with research and documentation of workflows and policies and procedures

Required Qualifications:

• Requires BA/BS in health sciences, health management, or nursing and minimum of 5 years of ICD-9 coding or medical record review experience in a consultative role; or any combination of education and experience, which would provide an equivalent background.

• CPC from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) and CPMA (Medical Auditing Certification) from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) or equivalent certification required.

Preferred Qualifications:

• Experience with Medicare Advantage and risk adjustment programs, including HCC coding.

• Experience auditing physician, outpatient, and/or hospital medical records.

• Experience interpreting and applying ICD-10-CM, CPT, HCPCS, and CMS guidelines.

• Experience developing and delivering provider or staff education.

• Strong knowledge of:

  • CMS regulations and Medicare risk adjustment methodologies

  • Medical record documentation standards

  • Federal healthcare compliance requirements

  • Coding and reimbursement principles

• Ability to analyze audit findings, identify trends, and recommend corrective actions.

• Strong written and verbal communication skills, including the ability to present audit results and educate providers.

• Proficiency with Microsoft Office applications and reporting tools.

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Workshift:

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Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.