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Centene Corporation · 1 day ago

Vice President, Enterprise Risk Adjustment

Missouri, United States

Full-time

Hybrid

Director/Executive

$250K/yr - $480K/yr

10+ years exp

Centene Corporation is transforming the health of our communities one person at a time. The Vice President, Enterprise Risk Adjustment is responsible for overseeing enterprise-wide risk adjustment policies and processes, driving the development and implementation of strategies to ensure accurate data submissions and compliance with regulatory requirements.

Hospital & Health Care

Responsibilities

Lead day-to-day operational efforts across all markets to ensure timely and accurate capture and submission of risk adjustment related data

Develop and execute enterprise-wide risk adjustment strategies to align with regulatory requirements and financial objectives

Align risk adjustment strategies with enterprise goals, ensuring consistency while allowing for market-specific customization

Serve as the executive sponsor for cross-functional initiatives impacting risk adjustment

Drive the adoption of enterprise-wide best practices, tools, and methodologies

Develop and implement standardized processes while enabling tailored approaches for unique market or product needs

Promote a culture of accountability, innovation and compliance

Foster a culture of operational excellence through Lean, Six Sigma, or similar methodologies

Identify and eliminate inefficiencies, redundancies, and compliance risks in existing workflows

Champion innovation and data-driven decision-making to enhance program outcomes

Collaborate with Chief Health Officer on provider education needs to ensure documentation and coding accuracy

Executive level reporting identifying actual to expected performance, outlier trends and prevalence opportunities

Oversee all risk adjustment-related compliance activities, including CMS RADV audits and internal/external reviews

Ensure timely and accurate submission of data in accordance with federal and state regulations

Monitor and ensure compliance with CMS, health plans, and state-specific regulations and audit requirements

Collaborate with Legal, Compliance, and Audit teams to mitigate risk and ensure audit readiness

Evaluate and optimize the vendor ecosystem to support scalability and innovation

Lead contract negotiations, performance management, and strategic alignment with all risk adjustment vendors

Establish KPIs and SLAs to ensure vendor accountability and value delivery

Translate complex risk adjustment data into actionable insights for executive leadership and the Board

Communicate risk exposure, financial impact, and progress toward strategic goals with clarity and precision

Serve as a thought leader and spokesperson for risk adjustment across the enterprise

Performs other duties as assigned

Complies with all policies and standards

Qualification

Risk adjustment expertiseCMS regulatory knowledgeVendor managementContract negotiationLean Six SigmaCPC certificationHealthcare operationsAnalytical skillsOperational rigorLeadership skillsCommunication skillsStrategic mindset