[Remote] Vice President, Risk Adjustment Program Operations & Data Integrity

Note: The job is a remote job and is open to candidates in USA. Centene Corporation is transforming the health of communities, and they are seeking a Vice President to lead their Corporate Risk Adjustment program operations. The role involves overseeing compliance, managing enterprise-wide operations, and ensuring data integrity and quality across various healthcare initiatives.

Responsibilities

• 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
• Complies with all policies and standards

Skills

• 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
• A flexible approach to work with remote, hybrid, field or office work schedules
• Total compensation may also include additional forms of incentives
• Benefits may be subject to program eligibility

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