Medicare Sales Compliance Specialist

Centene Corporation; Missouri; Remote; USD 55,000 - 99,000; Full time

Job summary

A leading company in the healthcare sector is seeking a Medicare Sales Compliance professional to manage regulatory requirements and oversee compliance activities. This position involves conducting audits, analyzing data for trends, and consulting on regulatory issues. The role supports a diverse team and offers flexibility with remote work options along with a comprehensive benefits package.

Benefits

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Flexible work schedules

Qualifications

• 3+ years of experience in Managed Care/Health Insurance/Public Health.
• Some experience in State or Federal managed care compliance required.

Responsibilities

• Supports Medicare Sales Compliance in management of regulatory requirements.
• Performs routine audits of sales activities and third-party materials.
• Analyzes audit data for trends and provides regulatory advice.

Skills

Regulatory analysis

Data analysis

Auditing

Education

Bachelor’s degree in Health Administration or related field

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States

Position Purpose: Supports the Medicare Sales Compliance team in the management of regulatory requirements associated with the Medicare sales compliance and third-party marketing materials. Consults on sales compliance topics, audits of Medicare sales activities and participates in the oversight, analysis, review, and approval of all third-party beneficiary-facing Medicare materials.

• Performs comprehensive, complex regulatory analyses, including the review, summarization and dissemination of key regulatory updates and changes.
• Performs routine audits of various sales activities, including sales events, third-party websites, and telephonic recordings.
• Provides regulatory support and advice to business owners as new regulations emerge. Partners with business areas to help ensure processes and policies are implemented to comply with CMS regulatory and contractual requirements.
• Analyzes audit data for trends, outliers, and spikes. Transforms data into presentations and recommendations for improved compliance
• Reviews all third-party marketing materials.
• Develops and hosts training sessions for business partners.
• Monitors and reports on the status of assigned projects, anticipating and identifying issues that could inhibit achieving the project goals and objectives, and implementing corrective actions and mitigation strategies.
• Provides project leadership, including the review of documents, summarizing results and implementing recommendations.
• Coordinates the filing of regulatory forms, reports, marketing materials, etc. May also assist other departments in understanding and complying with regulatory requirements and data entry of submission and preparation of regulatory forms, reports, and data.
• Tracks all sales issues referred to the Medicare Compliance Department up to and including resolution.
• Performs special projects as assigned.

Education/Experience:

• Bachelor’s degree in Health Administration, related field, or equivalent experience required.
• 3+ years of experience in Managed Care/Health Insurance/Public Health/Health Care Administration/ Medicare Part D or related field required.
• Some experience in State or Federal managed care compliance required.

Pay Range: $55,100.00 - $99,000.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act