Note: The job is a remote job and is open to candidates in USA. Health Net Health Plan of Oregon, Inc. is part of Centene, which is transforming the health of communities. The Vice President of Risk Adjustment Program Operations & Data Integrity will provide operational leadership for the Corporate Risk Adjustment program, overseeing compliance and leading enterprise-wide operations while ensuring data integrity and regulatory alignment.
Responsibilities
- 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
Skills
- Bachelor's degree in health information management, Nursing, Healthcare Administration, Business, or related field required
- 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
- Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position
- Advanced degree preferred
Benefits
- 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
Company Overview
Our mission at Health Net Health Plan of Oregon, Inc., “Health Net” is to transform the health of communities, one person at a time. It was founded in undefined, and is headquartered in Tigard, Oregon, US, with a workforce of 201-500 employees. Its website is http://www.healthnetoregon.com.