Medicare Compliance Advisor — Clinical & Quality

Centene Corporation; Lake Michigan Beach (MI); Vor Ort; USD 88.000 - 158.000; Vollzeit

Benefits dieser Stelle

Health insurance

401K & stock plans

Tuition reimbursement

Paid time off

Flexible work options

Zusammenfassung

Centene Corporation is seeking an accomplished Medicare Compliance Advisory professional to support the day-to-day execution of the Medicare Compliance Advisory program in line with CMS requirements. You will translate complex federal/state regulations into actionable guidance for stakeholders and help maintain audit readiness across operations.

The role requires 5+ years in compliance, regulatory or risk management in healthcare, with strong research, documentation and communication skills.

Qualifikationen

• Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required.
• Master’s Degree or Juris Doctor preferred.
• 5+ years Compliance, regulatory, operations, or risk management within a regulated industry (e.g., healthcare, managed care, insurance, or public sector).
• 4+ years Compliance advisory experience to include regulatory research and drafting compliance guidance, assessing risk, issue tracking, auditing / monitoring, and overseeing the development and implementation of correction action plans required.
• 2+ years experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.

Aufgaben

• Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
• Interprets and translates federal, state, and contractual requirements into clear, actionable compliance guidance for business stakeholders, ensuring consistent understanding and application across operations.
• Develops and coordinates regulatory communications, including responses to inquiries, issue summaries, and disclosures, while serving as a liaison with internal stakeholders and external regulators as appropriate.
• Supports the preparation, validation, and submission of regulatory reports, attestations, and filings, ensuring accuracy, completeness, and timeliness of all deliverables.
• Proactively identifies compliance risks and evaluates business processes to assess exposure, provide risk stratification, and recommend mitigation strategies.
• Leads or supports issue identification, root cause analysis, and development of corrective action plans to ensure effective and compliant resolution of identified gaps.
• Provides subject matter expertise to audit and monitoring activities, including supporting audit scope development, testing strategies, and ongoing compliance oversight.
• Partners with internal and external stakeholders to support audit execution, regulatory reviews, and ongoing audit readiness activities.
• Evaluates remediation plans and validates corrective actions to ensure sustainable and compliant resolution of issues, including assessment of regulatory reporting or disclosure requirements.
• Contributes to the development and delivery of compliance training, while mentoring stakeholders on regulatory requirements, policies, and best practices.
• Reviews and assesses policies, procedures, and business processes to ensure alignment with regulatory and contractual requirements and organizational standards.
• Leads or contributes to cross-functional initiatives to enhance compliance processes, drive operational efficiency, and align compliance activities with organizational objectives.
• Monitors regulatory developments and industry trends to identify emerging risks and support continuous improvement of compliance programs.
• Collaborates with compliance, legal, audit, and operational partners to ensure coordinated execution of compliance activities across business areas.
• Performs other duties as assigned.
• Complies with all policies and standards.

Kenntnisse

Regulatory compliance

Regulatory research

Issue tracking

Auditing/monitoring

Documentation

Written and verbal communication

Multitasking / deadline management

Ausbildung

Bachelor’s degree in a related field

Master’s Degree or Juris Doctor preferred

Jobbeschreibung

Centene Corporation is seeking an accomplished Medicare Compliance Advisory professional to support the day-to-day execution of the Medicare Compliance Advisory program in line with CMS requirements. You will translate complex federal/state regulations into actionable guidance for stakeholders and help maintain audit readiness across operations.

The role requires 5+ years in compliance, regulatory or risk management in healthcare, with strong research, documentation and communication skills.