California Compliance Leader - Health & HIPAA Programs

Centene Corporation; United States; Hybrid; USD 189,000 - 360,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Flexible work arrangements

Job summary

Centene Corporation in California seeks a senior compliance leader to ensure regulatory compliance with state and federal programs, including Health Net and Centene subsidiaries. You will develop policies, oversee audits, and guide multiple departments on regulatory changes, coordinating with senior management and the Board.

The role requires 8+ years of compliance program experience, extensive knowledge of state and federal regulations, and familiarity with HIPAA and TPAs.

Qualifications

• Bachelor's Degree in Public Policy, Government Affairs, Business Administration or related field required.
• 8+ years of compliance program management and contract experience required.
• Extensive knowledge of state administrative code and regulations, state insurance laws and regulations including managed care regulations.
• Experience with state and federal government agencies, accreditation bodies, participating provider agreements, HIPAA and Third Party Administration (TPA) laws, credentialing regulations and prompt pay laws.

Responsibilities

• Ensure Health Net and Centene Corporate are in compliance with state and federal program regulations, insurance regulations, regulatory requirements for business entities and state contract requirements.
• Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures.
• Develop policies, procedures, and processes to comply with state law, federal law, contract requirements, and various standards.
• Oversee, administer, and implement various compliance programs, including fraud and abuse and HIPAA.
• Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language.
• Conduct compliance audits, develop and implement corrective action plans, and report on achievement of action plans to senior management and Board of Directors.
• Develop strategic relationships with state legislative policymakers and assist with the development of state legislative public policy concerning state insurance, Managed Care Organization, Medicare and Medicaid regulations and initiatives.
• Identify, evaluate and analyze the impact of state legislative and regulatory issues and advise management concerning impact.
• Represent senior management at various committees, meetings, and seminars.
• Performs other duties as assigned.
• Comply with all policies and standards.

Skills

Regulatory compliance

Policy development

Audit management

HIPAA compliance

Education

Bachelor's Degree

Master's or J.D. preferred

Job description

Centene Corporation in California seeks a senior compliance leader to ensure regulatory compliance with state and federal programs, including Health Net and Centene subsidiaries. You will develop policies, oversee audits, and guide multiple departments on regulatory changes, coordinating with senior management and the Board.

The role requires 8+ years of compliance program experience, extensive knowledge of state and federal regulations, and familiarity with HIPAA and TPAs.