Vice President, Risk Adjustment Program Operations, Data Integrity

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $188.9k - $359.8k / year

⏰ Full Time

🔴 Lead

📋 Program Manager

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Healthcare Insurance • Non-profit • Social Impact

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Provide operational leadership for Centene's Corporate Risk Adjustment program operations and its subsidiaries. • Oversee compliance with Risk Adjustment data integrity and validation audit process. • Lead enterprise-wide Risk Adjustment operations for coding and external audits, ensuring consistent execution while addressing market, product, and regulatory variation. • Lead and develop high performing, multi-disciplinary teams through complex change, reinforcing accountability, engagement, and results. • Drive enterprise change management through standardized processes, tools, and controls that improve scalability, quality, and compliance. • Oversee encounter data submissions and reconciliation to ensure data completeness, accuracy, and regulatory alignment. • Effectively communicate risk, organizational impact and progress towards achieving goals. • Establish strong governance and oversight for Risk Adjustment compliance, including RADV and other regulatory and internal audits. • Work with local market teams as necessary to support Enterprise Risk Adjustment programs and education. • Ensure disciplined oversight of vendor performance, holding partners accountable to quality, timeliness, and contractual expectations. • Performs other duties as assigned.

🎯 Requirements

• Bachelor’s degree in health information management, Nursing, Healthcare Administration, Business, or related field required, advanced degree preferred • 10+ years of progressive leadership experience in Risk Adjustment, medical coding, healthcare compliance, or related regulated healthcare operations • Demonstrated experience leading large teams of certified coders, auditors, and quality professionals across multiple programs or markets. • Deep knowledge of CMS Risk Adjustment requirements, ICD 10 CM coding standards, RADV audits, and encounter data submissions. • Proven record of establishing coding governance, quality assurance, and audit readiness programs in highly regulated environments. • Executive level people leadership experience, including workforce development, performance management, and leading teams through change. • Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position

🏖️ Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules