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Risk Adjustment Administrative Representative

Location: WI
JobFamily: Administrative Support
Req #: PS73781
Date Posted: May 12, 2022

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SHIFT: Day Job

SCHEDULE: Full-time

Be part of an extraordinary team

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

The Risk Adjustment Administrative Representative is 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.


Minimum Requirements:

  • Requires High School diploma or GED equivalent

  • 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.

  • Travel may be required.

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at Anthem 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 [email protected] for assistance.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.