Risk Adjustment Compliance Manager

About the role

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 or Mason, OH. Alternate locations may be considered if candidates reside within a commuting distance from an office. 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.

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.

Pay & Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• 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

Schedule

Hybrid Workforce Strategy – associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.