Medicare Compliance Advisor - Remote

Centene Corporation; Clayton (NC); Ibrido; USD 88.000 - 158.000; Tempo pieno

Vantaggi offerti da questo lavoro

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

a flexible approach to work withremote

Descrizione del lavoro

Centene Corporation in Clayton, NC seeks a Medicare Compliance Advisory expert to lead day-to-day activities, interpreting CMS guidance and aligning with federal and state regulations. You will provide advisory support to leadership, perform regulatory research, track issues, and help prepare audit-ready deliverables.

You will partner with cross-functional teams, develop corrective action plans, support training, and help maintain ongoing compliance programs, ensuring accurate documentation and

Competenze

• Bachelor’s degree in a related field required; Master’s Degree or Juris Doctor preferred.
• 5+ years Compliance, regulatory, operations, or risk management within a regulated industry (healthcare, managed care, insurance, or public sector).
• 4+ years Compliance advisory experience including regulatory research and drafting compliance guidance, assessing risk, issue tracking, auditing/monitoring, and overseeing corrective action plans.
• 2+ years experience supporting managed care, Medicare Advantage/Part D, or DSNP programs.
• Foundational knowledge of Medicare regulations, CMS guidance and compliance expectations (Parts C & D).
• Strong written and verbal communication skills.
• Strong analytical, organizational and documentation skills with attention to detail.
• Ability to manage multiple assignments and meet deadlines in a fast-paced environment.

Mansioni

• Execute the Medicare Compliance Program in alignment with CMS and applicable regulations; ensure prevention, detection, and correction of noncompliance and FWA.
• Translate federal, state, and contractual requirements into clear, actionable compliance guidance for stakeholders.
• Develop regulatory communications and serve as a liaison with regulators as appropriate.
• Support preparation, validation, and submission of regulatory reports, attestations, and filings.
• Identify compliance risks, evaluate processes, provide risk stratification and mitigation strategies.
• Lead or support root cause analysis and corrective action plans to ensure effective resolution of gaps.
• Provide SME support to audit and monitoring activities including scope development and testing strategies.
• Partner with stakeholders to support audit execution and regulatory reviews.
• Evaluate remediation plans and validate corrective actions for sustainability.
• Contribute to development and delivery of compliance training; mentor stakeholders.
• Review policies and procedures for alignment with regulatory requirements and standards.
• Lead cross-functional initiatives to enhance compliance processes and efficiency.
• Monitor regulatory developments and industry trends to identify emerging risks.

Conoscenze

Regulatory research

Compliance guidance drafting

Issue tracking

Auditing & monitoring

Corrective action planning

Regulatory communication

Written & verbal communication

Analytical thinking

Organization & documentation

Deadline management

Formazione

Bachelor’s degree in healthcare administration / public health / policy

Master’s degree or Juris Doctor preferred

Descrizione del lavoro

Centene Corporation in Clayton, NC seeks a Medicare Compliance Advisory expert to lead day-to-day activities, interpreting CMS guidance and aligning with federal and state regulations. You will provide advisory support to leadership, perform regulatory research, track issues, and help prepare audit-ready deliverables.

You will partner with cross-functional teams, develop corrective action plans, support training, and help maintain ongoing compliance programs, ensuring accurate documentation and