Clinical Quality & Coding Lead - Risk Adjustment

Elevance Health; Indianapolis (IN); Hybrid; USD 120,000 - 180,000; Full time

Job summary

Elevance Health seeks a Manager to lead clinical performance and quality coding, ensuring accurate ICD-10 coding for provider visits. You will drive CMS Risk Adjustment efforts, mentor staff, and align clinical workflows with value capture objectives.

The role requires in-depth knowledge of HCC models, supervision experience, and a commitment to high-quality documentation across care settings.

Qualifications

• Requires a current, active NP or PA license from the resident state, and a master's in nursing (or PA equivalent).
• At least 3 years of clinical experience applying appropriate diagnosis in Medicare HCC Model, or equivalent background.
• Experience with CMS Risk Models is required.

Responsibilities

• Lead quality documentation and value capture for provider visit encounters with accurate ICD-10 coding.
• Develop and deliver clinically focused training on advanced coding and documentation with coder feedback.
• Collaborate with clinical leadership to align goals and workflows for value capture and high-quality documentation.
• Develop performance management plans, KPIs, and tracking for coding timeliness and accuracy.

Skills

Leadership

Training delivery

Clinical documentation

Education

Master's in Nursing or PA equivalent

NP/PA license in resident state

Tools

CMS Risk Models

Job description

Elevance Health seeks a Manager to lead clinical performance and quality coding, ensuring accurate ICD-10 coding for provider visits. You will drive CMS Risk Adjustment efforts, mentor staff, and align clinical workflows with value capture objectives.

The role requires in-depth knowledge of HCC models, supervision experience, and a commitment to high-quality documentation across care settings.