Vice President, Retrospective Programs (Remote)

Centene Corp.; Missouri; Hybrid; USD 189,000 - 360,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote,Hybrid

Total compensation may include bonuses

Job summary

Centene is seeking an Executive to lead the enterprise retrospective risk adjustment operations across Medicare, Marketplace, and Medicaid. The Vice President, Retrospective Programs will oversee chart retrieval, coding operations, quality, and analytics, guiding vendors and internal teams to deliver accurate, timely program outcomes.

You will build a high-performing team, translate complex data into executive insights, and partner with Finance, Compliance, Claims, and Market leads to ensure

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Finance, Clinical Discipline, Health Information Management, Analytics, or related field required.
• Master's degree in a related field preferred.
• 10+ years of progressive healthcare leadership experience, including risk adjustment, provider engagement, CDI, quality, claims, or vendor management.

Responsibilities

• Lead enterprise retrospective program strategy and execution across multiple markets.
• Oversee chart retrieval, coding operations, quality assurance, and analytics strategy.
• Manage vendor performance, SLAs, and procurement liaison activities.
• Translate complex operational data into executive-level insights and action plans.
• Develop and lead a high-performing team with a culture of accuracy and compliance.

Education

Bachelor's degree

Master's degree

Job description

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.

Position Purpose:

The Vice President, Retrospective Programs leads the enterprise retrospective risk adjustment operations team, with direct responsibility for functions including chart retrieval, coding operations, coding quality, supplemental data feeds, chart management, and retrospective analytics strategy across Centene's Medicare, Marketplace, and Medicaid markets. This position will oversee an internal enterprise operations team, manage vendors, and coordinate with market teams. This leader drives operational excellence, compliance discipline, vendor accountability, and cross-functional alignment to deliver accurate, timely, and sustainable program outcomes while also providing input into overall risk adjustment strategy.

Key Responsibilities

• Lead the enterprise retrospective program strategy and execution model
• Establish and maintain an end-to-end operating model that clearly defines roles, accountabilities, performance expectations, escalation paths, and decision rights across internal teams and vendor partners.
• Oversee chart retrieval operations to ensure targeted, timely, and complete medical record collection aligned to program goals, regulatory timelines, provider requirements, and health plan priorities.
• Drive retrieval and coding vendor oversight, including production performance, coding accuracy, quality monitoring, contract deliverables, service-level agreements, issue resolution, corrective action plans, and continuous improvement.
• Lead coding quality assurance programs to ensure accurate, compliant, and consistent coding practices, including second-level review, quality sampling, trend analysis, and remediation of coding defects or documentation gaps.
• Partner with Analytics to develop retrospective analytics, vendor performance insights, opportunity identification, forecasting, operational dashboards, and performance reporting.
• Serve as the business lead for vendor strategy, including vendor consolidation, strategic partner evaluation, cost optimization, capacity planning, contract negotiation and performance, and procurement liaison activities.
• Represent retrospective programs in enterprise governance forums, including Coding Committee, risk adjustment operating reviews, compliance forums, vendor governance, and executive operating reviews.
• Translate complex operational, coding, claims, and analytics information into clear executive-level insights, decisions, and action plans.
• Collaborate with Claims, Encounters, Data Integrity, Compliance, Finance, Provider Engagement, local markets, Network, and Technology to resolve operational barriers, improve chart-to-claim linkage, strengthen audit readiness, and ensure program outcomes are sustainable.
• Develop and lead a high-performing team, building leadership capability, operational discipline, accountability, talent development, and a culture focused on accuracy, compliance, transparency, collaboration, and continuous improvement.

Education/Experience

Bachelor's degree in Healthcare Administration, Business, Finance, Clinical Discipline, Health Information Management, Analytics, or related field required Master's degree in a related field preferred. 10+ years of progressive healthcare leadership experience, including risk adjustment, provider engagement, clinical documentation improvement, quality, claims, vendor management, or related healthcare operations required. Experience leading enterprise programs across multiple markets and lines of business required. Demonstrated success leading strategic initiatives, provider-facing programs, vendor partnerships, and cross-functional teams required. Strong knowledge of risk adjustment methodologies, healthcare operations, provider documentation, and regulatory requirements required. Proven executive leadership, communication, and stakeholder management skills required. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

Preferred

Preferred: 10+ years experience operations leadership experience, retrospective programs, coding, chart retrieval, quality data integrity. Experience leading Risk Adjustment functions across multiple markets and multiple lines of business (Medicare, Marketplace, Medicaid) National payer experience preferred.

Pay Range

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
• 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.

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.

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

Thanks for your interest in Centene and its subsidiary companies. Also, we’re here to help support you on your candidate journey. Should you need an accommodation, please email [e-mail]. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.