Medicare Compliance Advisor - Remote Audits & Grievances

Centene Corporation; Georgia; Híbrido; USD 120.000 - 165.000; Tempo integral

Resumo da vaga

Centene Corporation is seeking a Manager, Medicare Compliance Advisory to lead and support the day-to-day execution of CMS-aligned compliance activities. You will translate complex federal/state requirements into practical guidance for business leaders, support regulatory reporting, and drive corrective actions with a focus on audit readiness.

You will collaborate across compliance, legal, and operations to monitor regulatory developments, develop training, and strengthen the overall Medicare

Qualificações

• Bachelor’s degree in a related field or equivalent experience.
• 5+ years Compliance, regulatory, operations, or risk management within a regulated industry.
• ~4+ years Compliance advisory experience including regulatory research and drafting compliance guidance, risk assessment, auditing/monitoring, and overseeing correction action plans.
• Foundational knowledge of Medicare regulations, CMS guidance and compliance expectations (Parts C & D).
• Certified in Healthcare Compliance (CHC) preferred.

Responsabilidades

• Execute the Medicare Compliance Program in alignment with CMS and applicable regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
• Translate federal, state, and contractual requirements into clear, actionable compliance guidance for business stakeholders.
• Develop/regulate regulatory communications, including responses to inquiries and disclosures, liaising with regulators as appropriate.
• Support preparation, validation, and submission of regulatory reports, attestations, and filings.
• Identify compliance risks and evaluate processes to assess exposure and mitigation strategies.
• Lead or support root-cause analyses and corrective action plan development.
• Provide SME support for audits, monitoring, and audit readiness activities.
• Collaborate with stakeholders to support audits, regulatory reviews, and ongoing readiness.
• Evaluate remediation plans and validate corrective actions for sustainable resolution.
• Contribute to compliance training and mentor stakeholders on regulatory requirements.

Conhecimentos

Regulatory guidance

Risk management

Audit readiness

Issue tracking

Corrective actions

Training delivery

Stakeholder management

Policy review

Cross-functional collaboration

Continuous improvement

Formação

Bachelor's degree

CHC certification

Descrição da vaga

Centene Corporation is seeking a Manager, Medicare Compliance Advisory to lead and support the day-to-day execution of CMS-aligned compliance activities. You will translate complex federal/state requirements into practical guidance for business leaders, support regulatory reporting, and drive corrective actions with a focus on audit readiness.

You will collaborate across compliance, legal, and operations to monitor regulatory developments, develop training, and strengthen the overall Medicare