Manager, Compliance Risk Adjustment

Centene; United States; Remote; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Job summary

Centene is seeking a leadership-oriented individual to manage a team responsible for facilitating and leading external audits related to Risk Adjustment processes from a remote location across the Continental United States.

You will serve as the main contact with auditors, ensure timely submission of deliverables, and maintain comprehensive audit documentation. The role requires 5+ years in audit, risk adjustment, or compliance, with Medicare experience preferred.

Qualifications

• Bachelor's Degree in 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.

Responsibilities

• Serves as the point of contact for external audits and communicates with auditors regarding acknowledgement, deliverables timelines and inquiries.
• Manages external audit deliverables submission responsibilities and responds to inquiries from state and federal regulatory agencies in a timely manner.
• Quality Review all external audit deliverables for completeness and accuracy prior to submission to external auditors.
• Communicates with internal and external audit partners to clarify deliverables, audit requirements and deadlines.
• Acts as 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 external auditors.
• Maintains detailed audit documentation including meeting minutes, action items, 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

Bachelor's Degree in Audit, Compliance, Legal, or related field or equivalent experience

5+ years Audit, risk adjustment and/or compliance

Experience in risk adjustment oversight and/or coding planning

Medicare experience

Job description

Postition 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/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/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

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.

• 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.

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