Medicare Compliance Specialist — SNP Care & Quality

Centene Corporation; Yorktown (VA); Hybrid; USD 88,000 - 158,000; Full time

Job summary

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

The role provides regulatory guidance, conducts research, tracks issues, contributes to audit readiness, and supports the compliance work plan activities while partnering with the Sr. Manager to ensure timely, accurate documentation of risks, trends, and corrective actions.

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.
• 2+ years experience supporting managed care, Medicare Advantage/Part D, or DSNP programs.
• Foundational knowledge of Medicare regulations, CMS guidance.
• Strong written and verbal communication skills.

Responsibilities

• Execute the Medicare Compliance Program in alignment with CMS and applicable regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
• Interpret and translate federal, state, and contractual requirements into clear, actionable compliance guidance for business stakeholders.
• Develop regulatory communications, including responses to inquiries and disclosures, coordinating with regulators as appropriate.
• Support preparation, validation, and submission of regulatory reports, attestations, and filings.
• Identify compliance risks and evaluate business processes to assess exposure and mitigation strategies.
• Lead or support root cause analysis and corrective action plans for identified gaps.
• Provide SME support to audit and monitoring activities and assist in audit readiness.
• Collaborate with internal and external stakeholders to support audit execution and regulatory reviews.
• 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 to ensure alignment with regulatory and contractual requirements.

Job description

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

The role provides regulatory guidance, conducts research, tracks issues, contributes to audit readiness, and supports the compliance work plan activities while partnering with the Sr. Manager to ensure timely, accurate documentation of risks, trends, and corrective actions.