Risk Adjustment Specialist II - Non-Clinical (Remote) - Healthcare Operations and Strategy

Join the Centene Team as a Risk Adjustment Specialist II and Shape the Future of Healthcare

Are you passionate about improving healthcare outcomes and driving provider performance? Centene, a leading diversified, national healthcare organization, is seeking a highly skilled Risk Adjustment Specialist II to join our team. As a non-clinical specialist, you will play a critical role in enhancing provider engagement, coding, and documentation competencies, ultimately contributing to the health and well-being of our 28 million members.

About Centene and Our Culture

At Centene, we are committed to transforming the health of our communities, one person at a time. With a focus on diversity, equity, and inclusion, we value the unique perspectives and experiences that each team member brings. Our culture is built on a foundation of respect, empathy, and collaboration, allowing us to deliver high-quality healthcare services that meet the evolving needs of our members.

Our Mission and Values

Our mission is to improve the health and well-being of our members and the communities we serve. We are guided by a set of core values that emphasize:

• Member-centricity: We prioritize the needs and experiences of our members.
• Integrity: We operate with transparency, honesty, and ethics.
• Respect: We value diversity, equity, and inclusion.
• Accountability: We take ownership of our actions and outcomes.
• Excellence: We strive for continuous improvement and innovation.

Job Summary and Responsibilities

As a Risk Adjustment Specialist II, you will utilize risk adjustment methodologies, principles, and knowledge of managed care organizations to drive provider performance and improve coding and documentation competencies. This is a unique opportunity to work in a hybrid remote arrangement, with flexibility to work from home and occasional travel to areas surrounding Tempe and Tucson, Arizona.

Key Responsibilities:

• Provider Engagement and Education: Develop collaborative relationships with providers to educate and improve Risk Adjustment coding and documentation competencies.
• Training and Materials Development: Use knowledge of ICD10 guidelines to develop trainings and coding materials that enhance providers and staff engagement in coding and documentation initiatives.
• Data Analysis and Reporting: Utilize advanced Excel data and reporting skills to identify Risk Adjustment trends, barriers, and develop strategies and best practices for engagement.
• Communication and Collaboration: Collaborate within the health plan to develop newsletters and facilitate provider webinars and trainings.
• Claims and Medical Record Review: Apply clinical coding knowledge to review claims and medical records for appropriate documentation and coding.
• Independent Critical Thinking and Decision Making: Rely upon independent critical thinking and decision-making skills to assist providers with inquiries and barriers.
• Other Duties: Performs other duties as assigned and complies with all policies and standards.

Requirements and Qualifications

Education and Experience:

• Bachelor's Degree: In Health Promotion, Public Health, Health Administration, Business Administration, or a related field.
• Experience: 3+ years of equivalent experience in Health Insurance, Customer Service, Claims, or Provider Office.
• Knowledge: Knowledge of healthcare, managed care, and Risk adjustment methodologies is highly preferred.

Skills and Competencies:

• ICD10 Coding Knowledge: Familiarity with ICD10 guidelines and coding principles.
• Data Analysis and Reporting: Advanced Excel skills and ability to analyze and interpret data.
• Communication and Interpersonal Skills: Excellent communication, interpersonal, and presentation skills.
• Independent Critical Thinking and Decision Making: Ability to work independently and make sound decisions.

What We Offer

Compensation and Benefits:

• Competitive Salary: $25.97 - $46.68 per hour, depending on experience and qualifications.
• Comprehensive Benefits Package: Health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Flexible Work Arrangements: Hybrid remote work arrangement with flexibility to work from home and occasional travel.

Career Growth and Learning Opportunities:

• Professional Development: Opportunities for growth and development in a dynamic and evolving industry.
• Training and Education: Access to training and education programs to enhance skills and knowledge.
• Collaboration and Teamwork: Opportunity to work with a diverse and talented team.

Why Join Centene?

At Centene, we are committed to creating a workplace culture that values diversity, equity, and inclusion. We believe that our differences make us stronger and more resilient. By joining our team, you will have the opportunity to:

• Make a Meaningful Impact: Contribute to the health and well-being of our 28 million members.
• Grow and Develop: Access opportunities for professional growth and development.
• Work with a Diverse Team: Collaborate with a talented and diverse team.
• Enjoy a Flexible Work Environment: Take advantage of our hybrid remote work arrangement.

How to Apply

If you are a motivated individual ready to contribute to a thriving team, we encourage you to apply now! Please submit your application through our website:

We are excited to review your application and discuss this opportunity further.