Position Purpose:
The Vice President, Retrospective Programs leads the enterprise retrospective risk adjustment operations team, with direct responsibility for functions including chart retrieval, coding operations, coding quality, supplemental data feeds, chart management, and retrospective analytics strategy across Centene's Medicare, Marketplace, and Medicaid markets. This position will oversee an internal enterprise operations team, manage vendors, and coordinate with market teams. This leader drives operational excellence, compliance discipline, vendor accountability, and cross-functional alignment to deliver accurate, timely, and sustainable program outcomes while also providing input into overall risk adjustment strategy.
Key Responsibilities
- Lead the enterprise retrospective program strategy and execution model
- Establish and maintain an end-to-end operating model that clearly defines roles, accountabilities, performance expectations, escalation paths, and decision rights across internal teams and vendor partners.
- Oversee chart retrieval operations to ensure targeted, timely, and complete medical record collection aligned to program goals, regulatory timelines, provider requirements, and health plan priorities.
- Drive retrieval and coding vendor oversight, including production performance, coding accuracy, quality monitoring, contract deliverables, service-level agreements, issue resolution, corrective action plans, and continuous improvement.
- Lead coding quality assurance programs to ensure accurate, compliant, and consistent coding practices, including second-level review, quality sampling, trend analysis, and remediation of coding defects or documentation gaps.
- Partner with Analytics to develop retrospective analytics, vendor performance insights, opportunity identification, forecasting, operational dashboards, and performance reporting.
- Serve as the business lead for vendor strategy, including vendor consolidation, strategic partner evaluation, cost optimization, capacity planning, contract negotiation and performance, and procurement liaison activities.
- Represent retrospective programs in enterprise governance forums, including Coding Committee, risk adjustment operating reviews, compliance forums, vendor governance, and executive operating reviews.
- Translate complex operational, coding, claims, and analytics information into clear executive-level insights, decisions, and action plans.
- Collaborate with Claims, Encounters, Data Integrity, Compliance, Finance, Provider Engagement, local markets, Network, and Technology to resolve operational barriers, improve chart-to-claim linkage, strengthen audit readiness, and ensure program outcomes are sustainable.
- Develop and lead a high-performing team, building leadership capability, operational discipline, accountability, talent development, and a culture focused on accuracy, compliance, transparency, collaboration, and continuous improvement.
Education/Experience:
Bachelor's degree in Healthcare Administration, Business, Finance, Clinical Discipline, Health Information Management, Analytics, or related field required
Master's degree in a related field preferred.
10+ years of progressive healthcare leadership experience, including risk adjustment, provider engagement, clinical documentation improvement, quality, claims, vendor management, or related healthcare operations required.
Experience leading enterprise programs across multiple markets and lines of business required.
Demonstrated success leading strategic initiatives, provider-facing programs, vendor partnerships, and cross-functional teams required.
Strong knowledge of risk adjustment methodologies, healthcare operations, provider documentation, and regulatory requirements required.
Proven executive leadership, communication, and stakeholder management skills required.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
Preferred:
10+ years experience operations leadership experience, retrospective programs, coding, chart retrieval, quality data integrity.
Experience leading Risk Adjustment functions across multiple markets and multiple lines of business (Medicare, Marketplace, Medicaid) National payer experience preferred.
Pay Range: $188,900.00 - $359,800.00 per year
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.
