Staff VP Commercial Risk Adjustment

Anticipated End Date:

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Job Description:

Staff VP Commercial Risk Adjustment

Location: May be located in any Elevance Health PulsePoint office preferably in Mendota Heights MN Indianapolis IN Atlanta GA Mason OH New York NY Woodland Hills or Chicago IL.

This role requires associates to be in-office at least 3days 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. 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.

Summary

The Staff VP Commercial Risk Adjustment is responsible for setting and executing the enterprise strategy for commercial risk adjustment across fully insured and self-funded lines of business. This role owns program performance operating model design regulatory and audit readiness and cross-functional alignment to optimize risk score accuracy documentation integrity coding practices and financial outcomes. The Staff VP partners closely with enterprise functions and leaders to deliver measurable improvements in risk adjustment results while maintaining best-in-class governance and ethical standards.

Position Responsibilities

Strategy & Leadership

• Define and lead the multi-year commercial risk adjustment strategy roadmap and annual operating plan.

• Establish a scalable operating model (centralized market-based or hybrid) with clear accountability governance and performance management.

• Build mentor and lead high-performing teams across risk adjustment operations analytics provider education and program management.

• Serve as the executive point of accountability for commercial risk adjustment performance including reporting to senior leadership and relevant governance committees.

Program Performance & Financial Outcomes

• Own end-to-end performance across risk capture coding accuracy documentation improvement and submission processes to maximize appropriate risk recognition.

• Partner with Actuarial and Finance to quantify program impact forecast performance and manage variance to plan.

• Drive prioritization of interventions (e.g. suspecting chart review provider engagement clinical documentation improvement) based on ROI and risk.

• Ensure consistent measurement frameworks and KPI dashboards (e.g. risk score trends capture rates HCC prevalence coding accuracy submission timeliness).

Provider & Network Enablement

• Lead provider-facing risk adjustment enablement strategy including education feedback loops and workflow integration.

• Partner with Network/Provider Relations to incorporate risk adjustment performance expectations into value-based contracts where appropriate.

• Collaborate with EMR/EHR and vendor partners to improve clinical documentation workflows and reduce provider abrasion.

• Oversee development of actionable insights for provider groups.

Data Analytics & Technology Enablement

• Sponsor analytics and technology capabilities to support risk adjustment (e.g. suspecting models NLP chart retrieval workflow tools submission automation).

• Ensure strong data governance and data quality controls across clinical claims provider and vendor data sources.

• Partner with IT and Analytics to define requirements prioritize builds and ensure solutions are scalable secure and compliant.

• Evaluate select and manage vendors supporting risk adjustment operations and analytics.

Compliance Audit Readiness & Governance

• Establish and maintain policies procedures and controls that ensure compliant ethical risk adjustment practices.

• Ensure audit readiness and defensibility for all risk adjustment activities including documentation standards coding policies and vendor oversight.

• Partner with Compliance/Legal to interpret regulatory guidance and implement changes to policies and operations.

• Oversee internal monitoring risk assessments corrective action plans and ongoing education to minimize operational and regulatory risk.

Operational Excellence

• Document key processes and operational controls for key areas including chart acquisition coding review reconciliation and submissions.

• Implement continuous improvement using structured methodologies.

• Develop strong change management and communication plans to support adoption across clinical and operational stakeholders.

Position Requirements

Requires a BA/BS preferably in Business Health Administration Public Health Finance Data/Analytics and minimum of 10 years experience with healthcare economics and/or risk adjustment; or any combination of education and experience which would provide an equivalent background.

Preferred Skills Capabilities and Experiences

• 10 years of progressive leadership experience in health plan and/or provider risk adjustment payment integrity coding clinical documentation improvement or related functions strongly preferred.

• Deep knowledge of commercial risk adjustment methodologies and operations (e.g. diagnosis capture and coding workflows documentation standards submission processes) strongly preferred.

• Proven track record of delivering measurable financial and operational outcomes in a regulated environment.

• Demonstrated executive-level stakeholder management and the ability to influence across a matrixed environment.

• Strong command of compliance and control environments including audit readiness and governance practices.

• Advanced analytical and problem-solving skills; ability to translate data into operational action and executive-ready narratives.

• Experience implementing risk adjustment technology solutions (workflow platforms NLP/AI augmentation chart retrieval automation analytics tools).

• Familiarity with broader payment and quality programs (e.g. Stars/quality integration medical economics care management workflows).

• Masters degree (MBA MHA MPH) or equivalent advanced training.

• Professional credentials such as CPC CCS CRC RHIA/RHIT RN (or similar) or significant experience leading credentialed coding/clinical teams.

For candidates working in person or virtually in the below locations the salary* range for this specific position is $186880.00 to $336384.00.

Location(s): California; Illinois; Minnesota; New York.

In addition to your salary Elevance Health offers benefits such as a comprehensive benefits package incentive and recognition programs equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender race or any other category protected by federal state and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location work experience education and/or skill level. Even within the range the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned vested and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus commission benefits or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

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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.

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 may contact for assistance. 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 other words the job is posted until 3/13 not through 3/13.