Medicare Compliance Advisor Lead - Risk, Audit & Advisory

Centene Corporation; Lexington (KY); Hybrid; USD 120,000 - 170,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K & stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work arrangements

Job summary

Centene Corporation seeks a Manager for Medicare Compliance Advisory to guide day-to-day execution of the Medicare Compliance Program in line with CMS requirements and federal/state regulations.

You will translate complex regulations into clear guidance for stakeholders, support regulatory reporting, and help drive audit readiness and ongoing compliance improvements across the organization.

Qualifications

• Bachelor’s degree in a related field or equivalent experience required.
• 5+ years in Compliance, regulatory, operations, or risk management within a regulated industry.
• ~4+ years Compliance advisory experience including regulatory research and drafting guidance, risk assessment, and monitoring.
• Foundational knowledge of Medicare regulations, CMS guidance, and compliance expectations (Parts C & D).
• CHC certification preferred.
• Familiarity with CMS audit protocols, program audits, or monitoring activities preferred.

Responsibilities

• Execute the Medicare Compliance Program in alignment with CMS and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
• Translate federal, state, and contractual requirements into clear, actionable guidance for business stakeholders.
• Coordinate regulatory communications, responses, and disclosures with internal stakeholders and regulators as appropriate.
• Support preparation, validation, and submission of regulatory reports and attestations, ensuring accuracy and timeliness.
• Identify compliance risks, evaluate processes, and recommend mitigation strategies.
• Lead or support root cause analysis and corrective action plans for identified gaps.
• Provide SME support to audits, monitoring, and scope development.
• Collaborate with internal and external partners to support audit execution and regulatory reviews.
• Evaluate remediation plans and ensure sustainable resolution of issues.
• Contribute to the development and delivery of compliance training and mentoring.
• Review policies and procedures to ensure alignment with regulatory requirements.
• Support cross-functional initiatives to enhance compliance processes and drive efficiency.
• Monitor regulatory developments to identify emerging risks and drive continuous improvement.
• Coordinate with compliance, legal, audit, and operations to ensure aligned activities.
• Ensure compliance with all policies and standards.

Skills

Regulatory compliance

Risk management

Auditing & monitoring

Regulatory research

Issue tracking

Education

Bachelor’s degree in related field

CHC certification (preferred)

Job description

Centene Corporation seeks a Manager for Medicare Compliance Advisory to guide day-to-day execution of the Medicare Compliance Program in line with CMS requirements and federal/state regulations.

You will translate complex regulations into clear guidance for stakeholders, support regulatory reporting, and help drive audit readiness and ongoing compliance improvements across the organization.