Remote Audit Lead - Compliance Risk Adjustment
Centene Corporation
- Remote job
Centene Corporation is seeking a Risk Adjustment Audit Manager to oversee external audits and lead delivery of audit deliverables. The role focuses on ensuring accuracy, regulatory alignment, and timely communication with auditors across the risk adjustment function. You will collaborate with internal teams, manage corrective actions, and present performance reports to stakeholders to drive continuous improvements in risk adjustment processes and compliance. #J-18808-Ljbffr Centene Corporation
$87.7k - $157.8k
...responsible for facilitation and leading external audits related to Risk Adjustment processes. Ensures visibility by... ...prevention, detection, and correction of compliance issues as identified in external... ...job have the flexibility to work remote from home anywhere in the...Remote workRiskFull timePart timeWork at officeWork from homeFlexible hours- Managing business processes related to risk adjustment and quality improvement, the full-time Remote New York Risk Adjustment Manager will develop action plans, implement operational workflows, and evaluate strategies across various departments for assigned products and...Remote workRiskFull time
- Humana is seeking a Remote Risk Adjustment Coding Analyst to provide analytical and operational support across programs. You will analyze data... ..., and develop dashboards to monitor performance and compliance. This role emphasizes turning data into clear business narratives...Remote jobRisk
- Humana, Inc. is seeking a Risk Adjustment Coding Analyst to support data-driven decision making... ...reports to monitor analytics, compliance, and leadership priorities, and translate... ...and produce executive summaries. This remote role may require occasional travel and...Remote jobRisk
- Astrana Health, Inc. is seeking a Risk Adjustment Coding Specialist II to support our Houston market. This remote role focuses on high-volume chart reviews, identifying coding gaps, and delivering education to providers and practice leaders. You will track KPIs like HCC...Remote jobRiskLive in
- Trinity Health in Michigan seeks a Certified Risk Adjustment Coding Specialist for a fully remote position. You will assign ICD/CPT codes, abstract data from... ..., with initial in-person training and ongoing compliance duties. The role requires CRAC certification or active...Remote jobRiskShift work
- ...Summary The Supervisor, Risk Adjustment Quality Assurance and Auditing, is responsible for... ...role ensures the accuracy, compliance, and quality of the risk... ...Educator Manager and Training Lead in identifying areas of... ...There may be opportunity for remote work within all jobs...Remote workRiskContract workWork from homeHome office
$118.6k - $157.14k
...Reporting to the Director of Risk Adjustment Prospective Programs,... ..., and risk adjustment compliance, this role executes... ..., and maintaining audit readiness. Commitment... ...Diagnosis & Resolution: Lead technical root-cause analyses... .... (Monday & Friday - remote, Tuesday - Thursday...Remote workRiskTemporary workWork experience placementLocal areaMonday to Friday$31.03 - $36.03 per hour
...work experience. ~3 years of risk adjustment and/or hierarchical condition... ...Adjustment Data Validation audit activities. Experience reviewing... ...questions and determine compliance with coding guidelines... ...less experienced staff and may lead matrixed resources as needed....Remote workRiskTemporary workWork experience placement- Centene Corp. is seeking a Senior Actuary for a fully remote role across Eastern and Central time zones. You will conduct analysis, pricing, and risk assessment to estimate financial outcomes, supporting the Risk Adjustment team through data analytics, risk modeling, and...Remote jobRisk
- Humana Inc. is seeking a Risk Adjustment Coding Analyst to provide operational, analytical, and administrative support to business leaders... ...and recurring reports that support oversight, analytics, compliance monitoring, and leadership decision-making; you will analyze...Remote jobRisk
$143.62k - $229.79k
...Consulting Actuary -ACA Risk Adjustment As a Consulting Actuary -ACA Risk Adjustment, you... ...organization. Responsibilities include leading pricing strategies and actuarial initiatives... ...projects, ensuring timeliness, compliance, and quality of work Provide proactive...Remote workRisk$87.7k - $157.8k
...Position Purpose: Manage the business processes related to risk adjustment and quality improvement across Centene’s for assigned products... ...time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted...Remote workRiskFull timePart timeWork experience placementLive inWork at officeLocal areaFlexible hours- Florida Blue Group is seeking a Risk Adjustment Coder to work remotely and independently. You will review records, assign ICD-10 codes for risk adjustment, and ensure accuracy and compliance while meeting production targets. The role requires active CPC/CCSP or AHIMA certification...Remote jobRisk
$83.99k - $119.97k
...The Program Manager, Risk Adjustment & Stars, serves as the... ...friendly terms. ~ Leads cross-functional workgroups... ...payer partners. Compliance & Governance ~... .... ~ Supports RADV audit readiness and health plan... ...HIPAA compliant for all remote or telecommuting...Remote workRiskFull timeHome office- Coding & Risk Adjustment Specialist - Clinical Operations Company: Avail Health Location: Remote (U.S.) Employment Type: Part-Time, Independent Contractor... ...practices, conduct audits, and develop scalable workflows that support compliance and program performance. The...Remote workRiskPart timeFor contractorsFlexible hours
$160k - $195k
Sr. Director - Risk Adjustment Department: Quality - Risk Adjustment... ...processes, and lead teams through change.... ..., analytics, quality, compliance, and finance teams. Monitor... ...internal monitoring, audits, and regulatory review... ...Conditions This is a remote position. Travel is...Remote workRiskFull timeContract work$147.55k - $215.18k
...Senior Manager, Actuarial - Risk Adjustment to join our Actuarial team.... ...Location: This position is fully remote and open to candidates... ...adjustment performance. Lead quarterly audit deliverables and maintain internal control compliance to support accurate financial...Remote workRiskFull timeWork from homeHome office- ...Supporting departmental Quality Assessment audits, the full-time Certified Risk Adjustment Coder will manage coding accuracy and... ...integrity for Medicare Risk Adjustment, working remotely to enhance performance standards and compliance. Key responsibilities Conduct regular...Remote workRiskFull time
- CCMSI, a leading national TPA, seeks a Multi-Jurisdiction Claims Adjuster for auto and property damage within a... ...accounts program. This remote role handles end-to-end... ...with clients, conduct risk assessment, maintain reserves, and ensure compliance with Corporate Claim Standards...Remote jobRisk
$196.73k - $286.9k
...Director, Actuarial - Risk Adjustment to join our Actuarial... ...Actuarial – Risk Adjustment leads Oscar's ACA risk... ...This position is fully remote and open to candidates... ...monthly close, external audits, regulatory reviews,... ...laws, regulations, and compliance requirements....Remote workRiskFull timeWork from homeHome office- Rubrik is seeking a Senior Commercial Compliance Analyst to own its portfolio of security certifications and audits from evidence collection through auditor management to... ...manage certification lifecycles, partner with risk management, and leverage AI-enabled workflows...Remote jobRisk
- ...Insurance Companies is expanding its Compliance team and seeking an Underwriting Audit Supervisor. The role oversees the... ...to improve performance and risk management. Candidates should have... ...leadership. A hybrid work model and remote consideration are offered to qualified...Remote jobRisk
$70k - $85k
Risk Adjustment Coding Specialist II - REMOTE CST/EST Department: Quality - Risk Adjustment Employment... ...and/or coding quality audits of medical records to... ...knowledge of coding regulations, compliance guidelines, and updates... ...manager. May assist or lead projects and/or higher...Remote jobRiskFull timeLive inWork at officeHome office$143.62k - $229.79k
...Remote Flex - North Carolina Remote Flex - Mississippi Remote... ...a Consulting Actuary - ACA Risk Adjustment, you will serve as a... ...projects, ensuring timeliness, compliance, and quality of work Provide... ...care is changing, and we're leading the way. We offer more than...Remote workRiskFull timeWork at officeLocal areaFlexible hours2 days per week- Haynie & Company is seeking an Audit Manager in the United States Colorado Littleton area to lead audits from planning through completion... ...ensuring quality and regulatory compliance. You will act as trusted advisor to clients, identify risks, and deliver actionable insights...Remote jobRisk
$134.6k - $249k
...Purpose: Provides executive leadership for risk adjustment performance across markets and lines of... ...execution and measurable results. Leads cross-functional initiatives to improve... ...holidays, and a flexible approach to work with remote, hybrid, field or office work schedules....Remote workRiskFull timePart timeH1bWork at officeFlexible hours$58.7k - $70.4k
Remote The Risk Adjustment Coding Analyst provides operational, analytical, and administrative support... ...operational oversight, analytics, compliance monitoring, and leadership decision-making... ...work analyses, activity tracking, audit reporting, GenAI-related reporting, CDI...Remote workRiskFull timeWork at officeWork from homeHome office- Alignment Health is seeking a Remote Auditor to conduct UM and CM audits for delegated entities, ensuring compliance with CMS, contractual... ...internal policies. You will lead audit activities, communicate... ...providers.The role emphasizes risk-based auditing, documentation...Remote jobRisk
- VPD Government Solutions is seeking aSenior TANF Program Integrity Specialist to lead complex contractor support for OFA compliance monitoring, audit support, and risk-based oversight of state TANF programs. You will apply advanced knowledge of TANF requirements, federal...Remote jobRiskFor contractors
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