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Medical Investigations Analyst I

2 months ago

Richmond, United States Elevance Health Full time

Medical Investigations Analyst I

Location: This position is virtually based. This position will take part in Elevance Health's hybrid workforce strategy which includes virtual-based work and onsite requirements as needed by the department only.

Although this position is virtually based our ideal candidate will still live within a reasonable proximity (1-hour commute and a 50-mile radius) to one of the above-listed Elevance Health major office locations.

Schedule: Monday- Friday, 8:00 AM 5:00 PM, within the candidates respective time zone. There is some flexibility in the scheduled hours start and end times.

The Medical Investigations Analyst I is responsible for assisting the risk adjustment teams of Elevance Health access and determine the health risk of our members. By working in this role, you are aiding in the collection of medical records that have missing ICD-10 chart information that potentially hold HCC (Hierarchical Condition Category) value.

How You Will Make an Impact

Primary duties may include, but are not limited to:

  • Generates letters to providers to request information and assist in the acquisition of medical records.

  • Request chart and handle escalations for RADV CMS Audit.

  • Some Administrative Tasks -faxing, downloading of records, reviewing of invoices.

  • Assist vendors in PNPs (issues log) to problem solve for charts they cant get in for us.

  • Use claims to research bad data that keeps one from chasing medical records.


Minimum Requirements:

  • Requires an AS in Health Sciences or related health care field and/or a minimum of 1 year experience in a healthcare-related field and health care insurance; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

  • Ability to multi-task and have a high attention to detail.

  • Effective oral and written communication skills.

  • Experience and comfortability making phone calls to providers and hospitals strongly preferred. Roughly 80% of this position will be spent making outbound calls.

  • Proficient in Microsoft Office Programs; specifically intermediate-level Excel skills.


For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $22.89 per hour to $41.20 per hour.

Locations: California; Colorado; District of Columbia (Washington, DC); Nevada; New York; Washington State

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 considered to be 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 Company's sole discretion unless and until paid and may be modified at the Companys sole discretion, consistent with the law.