Medicare Compliance Advisor — Grievances & Audit Readiness

Centene Corporation; Alton (IL); Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off and holidays

Flexible hybrid/remote work schedules

Job summary

Centene Corporation seeks an experienced Medicare Compliance Advisory subject matter expert to support day-to-day execution of the program in alignment with CMS requirements and regulations. You will provide regulatory guidance, conduct research, track issues, and support audit readiness and workplan activities.

You will translate requirements into actionable guidance, develop communications, and collaborate with internal and external stakeholders to ensure timely deliverables and effective

Qualifications

• Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required.
• 5+ years Compliance, regulatory, operations, or risk management within a regulated industry.
• 4+ years Compliance advisory experience: regulatory research, drafting guidance, risk assessment, auditing/monitoring, action plans.
• 2+ years experience with managed care, Medicare Advantage/Part D, or Dual Eligible programs.
• Foundational knowledge of Medicare regulations and CMS guidance.
• Strong written and verbal communication skills.
• Analytical, organizational, and documentation skills with attention to detail.
• Ability to manage multiple assignments and meet deadlines.

Responsibilities

• Execute the Medicare Compliance Program in alignment with CMS and federal/state regulations to prevent, detect, and correct noncompliance and FWA.
• Translate federal, state, and contractual requirements into clear compliance guidance for stakeholders.
• Develop regulatory communications and liaise with regulators as appropriate.
• Support preparation and submission of regulatory reports, attestations, and filings with accuracy and timeliness.
• Identify compliance risks, evaluate processes, and provide mitigation strategies.
• Lead or support root-cause analysis and corrective action plans for identified gaps.
• Provide SME support to audits and monitoring activities and testing strategies.
• Partner with stakeholders to support audit execution and regulatory reviews.
• Evaluate remediation plans and validate corrective actions for sustainable resolution.
• Contribute to training and mentoring on regulatory requirements and best practices.
• Review policies and processes for alignment with regulations and standards.
• Lead cross-functional initiatives to improve compliance processes and efficiency.
• Monitor regulatory developments and industry trends for risk identification.
• Collaborate with legal, audit, and operations to coordinate compliance activities.
• Perform other duties and comply with policies.

Skills

Regulatory guidance

Regulatory research

Issue tracking

Audit readiness

Regulatory communications

Data/documentation

Stakeholder collaboration

Regulatory trend monitoring

Education

Bachelor’s degree in related field

Master’s degree or JD preferred

CHC certification preferred

Job description

Centene Corporation seeks an experienced Medicare Compliance Advisory subject matter expert to support day-to-day execution of the program in alignment with CMS requirements and regulations. You will provide regulatory guidance, conduct research, track issues, and support audit readiness and workplan activities.

You will translate requirements into actionable guidance, develop communications, and collaborate with internal and external stakeholders to ensure timely deliverables and effective