Senior Compliance Risk Adjustment Analyst

Centene Corporation•Northampton, MA

13d•Remote

About The Position

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. Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. Position Purpose: Supports the Risk Adjustment Compliance program elements, with a focus on the auditing and monitoring functions. Collaborates with business areas to ensure effective prevention, detection, and correction of compliance issues. Facilitates and leads external audits related to Risk Adjustment processes. Ensures visibility by way of reporting out audit deliverables and risk related to each audit. Serves as the point of contact for external audits, and correspond with auditors related to audit acknowledgement, deliverables timelines and other inquiries. Manages external audit deliverables submission responsibilities and responds to inquiries from state and federal regulatory agencies timely. Quality Review all external audit deliverables for completeness and accuracy prior to submission to external auditors. Communicates with both internal and external audit partners to clarify deliverables, audit requirements and deadlines. Serves as a risk adjustment external audit resource and liaison on external audit policies, communications, external audit workflow, and quality improvements initiatives. Socializes identified risks with internal partners including the Compliance Corrections team by timely entering Corrective Action Intake. Supports the Corrective Action Plan development and reviews prior to submission to the external auditors. Effectively creates and communicates audit milestone progress reporting. Maintains detailed audit documentation including meeting minutes, action items, identified issues, and risk management plans. Performs other duties as assigned. Complies with all policies and standards.

Requirements

Bachelor's Degree Audit, Compliance, Legal or related field; or equivalent experience required
3+ years Audit, risk adjustment and/or compliance required
Risk Adjustment/HCC coding required
Medicare experience required
Active Coding Credential from AHIMA or AAPC required

Nice To Haves

Demonstrated understanding of risk adjustment regulatory landscape preferred
Risk Adjustment regulatory audit experience preferred
CPMA, RHIA, RHIT or Risk Adjustment Credential preferred

Responsibilities

Supports the Risk Adjustment Compliance program elements, with a focus on the auditing and monitoring functions.
Collaborates with business areas to ensure effective prevention, detection, and correction of compliance issues.
Facilitates and leads external audits related to Risk Adjustment processes.
Ensures visibility by way of reporting out audit deliverables and risk related to each audit.
Serves as the point of contact for external audits, and correspond with auditors related to audit acknowledgement, deliverables timelines and other inquiries.
Manages external audit deliverables submission responsibilities and responds to inquiries from state and federal regulatory agencies timely.
Quality Review all external audit deliverables for completeness and accuracy prior to submission to external auditors.
Communicates with both internal and external audit partners to clarify deliverables, audit requirements and deadlines.
Serves as a risk adjustment external audit resource and liaison on external audit policies, communications, external audit workflow, and quality improvements initiatives.
Socializes identified risks with internal partners including the Compliance Corrections team by timely entering Corrective Action Intake.
Supports the Corrective Action Plan development and reviews prior to submission to the external auditors.
Effectively creates and communicates audit milestone progress reporting.
Maintains detailed audit documentation including meeting minutes, action items, identified issues, and risk management plans.
Performs other duties as assigned.
Complies with all policies and standards.