Senior Manager, Risk Adjustment

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

• Evaluate and manage the risk adjustment strategy across all functional areas that impact assigned products
• Develop and maintain all policy and procedures for departmental processes
• Develop and implement action plans by partnering with all departments affecting assigned products and plans, to address issues identified by the business units, including detailed workplans, issue logs, and progress reports
• Assist in composing provider education for correct coding according to state and federal risk adjustment guidelines
• Work with vendor coding leadership to ensure risk adjustment work being undertaken on behalf of Centene meets all state and federal guidelines for risk adjustment code capture and contractual service level agreements
• Prepare dashboards, reports, and analytics for senior management and identify improvement opportunities

Education and Experience: Bachelor's degree in applicable field or equivalent experience required. 5+ years of project management, operations, or quality improvement in the healthcare industry. Experience in risk adjustment or medical record audit preferred. Thorough knowledge of administrative, data management and audit functions. Management/supervisory experience required. License and Certifications: CPC, CPC-H, CPC-P, CCS, CCs-P, RHIA or CPMA preferred. CRC or MARSI risk adjustment certification preferred.

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

Originally posted on Himalayas