Remote Risk Adjustment Audit Manager

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

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.