Medicare Compliance Strategy Lead

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

Benefits offered by this job

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off

Flexible work arrangements

Job summary

Centene Corporation is seeking a Medicare Compliance Advisory expert to support the day-to-day execution of the program, ensuring alignment with CMS requirements and applicable federal and state regulations. You will provide advisory support to business and compliance leadership, conduct research, track issues, and contribute to audit readiness.

The role partners with the Sr. Manager to interpret CMS guidance, document risks, and develop corrective actions.

Qualifications

• Bachelor’s degree in a related field or equivalent experience required.
• 5+ years in Compliance, regulatory, operations, or risk management within regulated industry.
• 4+ years Compliance advisory including regulatory research and drafting compliance guidance, assessing risk, issue tracking, auditing / monitoring, and overseeing the development and implementation of correction action plans required.
• 2+ years experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.
• Foundational knowledge of Medicare regulations, including CMS guidance and compliance expectations (e.g., Parts C & D)
• Strong written and verbal communication skills.
• Familiarity with CMS audit protocols, program audits, or monitoring activities preferred.

Responsibilities

• Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
• Interprets and translates federal, state, and contractual requirements into clear, actionable compliance guidance for business stakeholders, ensuring consistent understanding and application across operations.
• Develops and coordinates regulatory communications, including responses to inquiries, issue summaries, and disclosures, while serving as a liaison with internal stakeholders and external regulators as appropriate.
• Supports the preparation, validation, and submission of regulatory reports, attestations, and filings, ensuring accuracy, completeness, and timeliness of all deliverables.
• Proactively identifies compliance risks and evaluates business processes to assess exposure, provide risk stratification, and recommend mitigation strategies.
• Leads or supports issue identification, root cause analysis, and development of corrective action plans to ensure effective and compliant resolution of identified gaps.
• Provides subject matter expertise to audit and monitoring activities, including supporting audit scope development, testing strategies, and ongoing compliance oversight.
• Partners with internal and external stakeholders to support audit execution, regulatory reviews, and ongoing audit readiness activities.
• Evaluates remediation plans and validates corrective actions to ensure sustainable and compliant resolution of issues, including assessment of regulatory reporting or disclosure requirements.
• Contributes to the development and delivery of compliance training, while mentoring stakeholders on regulatory requirements, policies, and best practices.
• Reviews and assesses policies, procedures, and business processes to ensure alignment with regulatory and contractual requirements and organizational standards.
• Leads or contributes to cross-functional initiatives to enhance compliance processes, drive operational efficiency, and align compliance activities with organizational objectives.
• Monitors regulatory developments and industry trends to identify emerging risks and support continuous improvement of compliance programs.
• Collaborates with compliance, legal, audit, and operational partners to ensure coordinated execution of compliance activities across business areas.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Regulatory research

Compliance guidance

Auditing/monitoring

Issue tracking

Strong communication

Risk management

Education

Bachelor’s degree

Master’s or JD preferred

CHC certification preferred

Job description

Centene Corporation is seeking a Medicare Compliance Advisory expert to support the day-to-day execution of the program, ensuring alignment with CMS requirements and applicable federal and state regulations. You will provide advisory support to business and compliance leadership, conduct research, track issues, and contribute to audit readiness.

The role partners with the Sr. Manager to interpret CMS guidance, document risks, and develop corrective actions.