Manager, Compliance Risk Adjustment

Centene Management Company LLC; Missouri; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Flexible work arrangements

Job summary

Centene Management Company LLC is seeking a senior professional to lead external audits of Risk Adjustment processes from a remote location in the United States. You will serve as the primary liaison with auditors, manage deliverables timelines, and ensure accuracy and compliance across audit activities.

Ideal candidates have 5+ years in audit/compliance, with knowledge of Medicare risk adjustment. A Bachelor's degree in a related field is required, and familiarity with corrective action plans

Qualifications

• Bachelor's Degree in Audit, Compliance, Legal, or related field.
• 5+ years of Audit, risk adjustment and/or compliance experience.
• Experience in risk adjustment oversight or coding planning preferred.
• Understanding of risk adjustment regulatory landscape, Medicare preferred.
• Medicare experience preferred.

Responsibilities

• Lead external audits for Risk Adjustment processes and serve as main contact with auditors.
• Ensure timely submission of audit deliverables and respond to inquiries from regulatory agencies.
• Quality review all external audit deliverables for completeness and accuracy.
• Collaborate with internal partners to communicate requirements and deadlines.
• Prepare and present reports on risk adjustment audit performance to stakeholders.

Skills

Audit experience

Compliance

Risk adjustment

Regulatory knowledge

Leadership

Education

Bachelor's Degree in Audit/Compliance/Legal or related field

Job description

Position Purpose

Manages a team responsible for facilitation and leading external audits related to Risk Adjustment processes. Ensures visibility by way of reporting out audit deliverables and associated risk related for each audit. Collaborates with business areas to ensure effective prevention, detection, and correction of compliance issues as identified in external audits.

Key Details

Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. Serves as the point of contact for external audits, and correspond with auditors related to audit acknowledgement, deliverables timelines and other inquiries. Manages external audit deliverables submission responsibilities and respond to inquiries from state and federal regulatory agencies timely. Quality Review all external audit deliverables for completeness and accuracy prior to submission to external auditors. Communicate with both internal and external audit partners to clarify deliverables, audit requirements and deadlines. Serves as a subject matter expert on external audit processes, policies, and quality improvement initiatives. Socializes identified risks with internal partners including the Compliance Corrections team by timely entering Corrective Action Intake. Supports the Corrective Action Plan development and review prior to submission to the external auditors. Maintains detailed audit documentation including meeting minutes, action items, identified issues, and risk management plans. Prepares and presents reports to stakeholders on risk adjustment audit performance and progress. Supports strategy development to enhance risk adjustment accuracy and operational efficiency. Provides operational and analytical support to the Risk Adjustment department. Researches and recommends best practices for continuous improvement in risk adjustment. Performs other duties as assigned. Complies with all policies and standards.

Education and Experience

Bachelor's Degree Audit, Compliance, Legal, or related field or equivalent experience required 5+ years Audit, risk adjustment and/or compliance required Previous experience in risk adjustment oversight and/or coding planning preferred Demonstrated understanding of risk adjustment regulatory landscape preferred Risk Adjustment regulatory audit experience preferred Medicare experience preferred.

Licenses or Certifications

Active Coding Credential from AHIMA or AAPC preferred CPMA, RHIA, RHIT or Risk Adjustment Credential preferred.

Pay Range

$87,700.00 - $157,800.00 per year.

Benefits

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.

Pay Details

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.

About Centene

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Equal Opportunity Statement

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.