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Centene Corporation

Centene Corporation is a Fortune 500, mission-driven healthcare leader committed to transforming the health of the communities we service, one person at a time.

Vice President, Risk Adjustment Program Operations and Data Integrity

Location

Florida

Posted

21 days ago

Salary

$188.9K - $359.8K / year

Seniority

Lead

Bachelor Degree

Job Description

Vice President, Risk Adjustment Program Operations and Data Integrity

Centene Corporation

Vice President, Risk Adjustment Program Operations & Data Integrity Remote-FL time type Full time   Position Purpose: 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. - Complies with all policies and standards.     Education/Experience: - 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.     Pay Range: $188,900.00 - $359,800.00 per year   Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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