Risk Adjustment Administrative Representative

Anticipated End Date:

2026-11-19

Position Title:

Risk Adjustment Administrative Representative

Job Description:

Risk Adjustment Administrative Representative

Location: Any Elevance Health PulsePoint.

Hybrid 1: 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 accommodation is granted as required by law.

The Risk Adjustment Administrative Representative will be responsible for obtaining accurate healthcare information from providers to ensure appropriate clinical care for members and maintain accurate payment levels. Performs highly specialized administrative, operational and/or customer support duties.

How you will make an impact:

• Conducts analysis of data, provider or member outreach, and/or record retrieval.
• Assists in the acquisition of medical records.
• Loads medical records into coding system and links records to appropriate chart IDs.
• Facilitates transfer of data and information in support of risk adjustment programs between providers and the company.
• Downloads medical records from Electronic Medical Record (EMR) systems remotely and in person.
• Assists with the medical record quality assurance process as necessary.
• Performs or participates in special projects as directed.
• Manages, maintains, and tracks ad hoc retrospective projects as assigned.
• Provides medical record retrieval process service to value-based groups and providers/groups new to the company.
• Prioritizes work across providers and/or external vendors including coordinating work activities and monitoring progress towards retrieval scheduling to meet weekly/ yearly goals, and/or is the primary administrative owner of a main process, program, product, or technology.
• Travels to worksite and other locations as necessary.

Minimum Requirements: Requires H.S. diploma or equivalent and a minimum of 2 years of experience performing medical records retrieval, in a provider office, hospital, insurance or healthcare administration; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• BA/BS in healthcare, business or other similar discipline preferred.
• Proficiency in Microsoft Office applications, including Word and Excel strongly preferred.
• Strong knowledge of ICD-9/10 codes preferred.

Job Level:

Non-Management Non-Exempt

Workshift:

1st Shift (United States of America)

Job Family:

ADM > Office/Admin Support

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.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, 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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.