Provide operational leadership for Centene's Corporate Risk Adjustment program operations and its subsidiaries
Oversee compliance with Risk Adjustment data integrity and validation audit process
Lead enterprise-wide Risk Adjustment operations for coding and external audits, ensuring consistent execution while addressing market, product, and regulatory variation
Lead and develop high performing, multi-disciplinary teams through complex change, reinforcing accountability, engagement, and results
Drive enterprise change management through standardized processes, tools, and controls that improve scalability, quality, and compliance
Oversee encounter data submissions and reconciliation to ensure data completeness, accuracy, and regulatory alignment
Effectively communicate risk, organizational impact and progress towards achieving goals
Establish strong governance and oversight for Risk Adjustment compliance, including RADV and other regulatory and internal audits
Work with local market teams as necessary to support Enterprise Risk Adjustment programs and education
Ensure disciplined oversight of vendor performance, holding partners accountable to quality, timeliness, and contractual expectations
Performs other duties as assigned.
Complies with all policies and standards.

Bachelor’s degree in health information management, Nursing, Healthcare Administration, Business, or related field required, advanced degree preferred
10+ years of progressive leadership experience in Risk Adjustment, medical coding, healthcare compliance, or related regulated healthcare operations
Demonstrated experience leading large teams of certified coders, auditors, and quality professionals across multiple programs or markets
Deep knowledge of CMS Risk Adjustment requirements, ICD 10 CM coding standards, RADV audits, and encounter data submissions
Proven record of establishing coding governance, quality assurance, and audit readiness programs in highly regulated environments
Executive level people leadership experience, including workforce development, performance management, and leading teams through change.

Vice President, Risk Adjustment Program Operations, Data Integrity

Key skills