Medicare Compliance Advisor - Regulatory & Audit Lead

Centene Corporation; Florida; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements (remote, in

Job summary

Centene Corporation is seeking an experienced Medicare Compliance Advisor to support day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements and state regulations.

The role provides regulatory guidance, conducts research and analysis, tracks issues, supports audit readiness, and collaborates with stakeholders to mitigate risks and ensure compliant operations across the organization.

Qualifications

• 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.
• 4+ years Compliance advisory experience including regulatory research and drafting guidance, risk assessment, auditing/monitoring, and corrective action plans.
• 2+ years experience supporting managed care programs such as Medicare Advantage/Part D or DSNP.

Responsibilities

• Execute the Medicare Compliance Program in alignment with CMS and state regulations, preventing, detecting, and correcting noncompliance and FWA.
• Translate federal, state, and contractual requirements into clear guidance for business stakeholders.
• Develop regulatory communications and disclosures, liaising with regulators as appropriate.
• Support preparation and submission of regulatory reports and attestations with accuracy and timeliness.
• Identify compliance risks, evaluate processes, and recommend mitigation strategies.
• Lead or support root-cause analysis and corrective action plans for gaps.
• Provide SME support to audit and monitoring activities and testing strategies.
• Collaborate with stakeholders to support audits, regulatory reviews, and readiness activities.
• Evaluate remediation plans and validate corrective actions for sustainable resolution.
• Contribute to compliance training and mentoring on regulatory requirements and policies.
• Review policies and processes for alignment with regulatory and contractual requirements.
• Drive cross-functional initiatives to enhance compliance and operational efficiency.
• Monitor regulatory developments to identify emerging risks and drive program improvements.

Skills

Written communication

Verbal communication

Analytical skills

Organizational skills

Documentation

Education

Bachelor's degree in related field

Master's Degree or JD preferred

Job description

Centene Corporation is seeking an experienced Medicare Compliance Advisor to support day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements and state regulations.

The role provides regulatory guidance, conducts research and analysis, tracks issues, supports audit readiness, and collaborates with stakeholders to mitigate risks and ensure compliant operations across the organization.