Remote Medicare Compliance Advisor

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

Benefits offered by this job

Health insurance

401(k) and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Job summary

Centene Corporation in the United States seeks an experienced Medicare Compliance Advisor to support the day-to-day execution of the Medicare Compliance Advisory program in line with CMS requirements. You will translate complex regulations into actionable guidance for business stakeholders and assist with regulatory reporting and audit readiness.

You will identify risks, lead root-cause analyses, and help develop corrective actions while partnering with leadership to ensure timely, accurate

Qualifications

• Bachelor's degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required.
• 5+ years Compliance, regulatory, operations, or risk management within a regulated industry (e.g., 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.
• CHC certification preferred.
• Familiarity with CMS audit protocols, program audits, or monitoring activities preferred.
• Experience working in a matrixed or cross-functional environment preferred.

Responsibilities

• Execute the Medicare Compliance Program in alignment with CMS and 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, issue summaries, and disclosures, coordinating with internal stakeholders and regulators.
• 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 analyses and corrective action plans.
• Provide SME support to audit and monitoring activities, including testing strategies and ongoing oversight.
• Collaborate with stakeholders to support audit execution, regulatory reviews, and audit readiness.
• Evaluate remediation plans and validate corrective actions for sustainable resolution.
• Contribute to compliance training and mentor stakeholders on regulatory requirements.
• Review policies, procedures, and processes for regulatory alignment.
• Contribute to cross-functional initiatives to enhance compliance processes and efficiency.
• Monitor regulatory developments and industry trends to identify risks.
• Collaborate with compliance, legal, audit, and operations across business areas.

Skills

Written & verbal communication

Analytical skills

Documentation skills

Cross-functional collaboration

Education

Bachelor's degree in related field

Master's degree or JD preferred

Job description

Centene Corporation in the United States seeks an experienced Medicare Compliance Advisor to support the day-to-day execution of the Medicare Compliance Advisory program in line with CMS requirements. You will translate complex regulations into actionable guidance for business stakeholders and assist with regulatory reporting and audit readiness.

You will identify risks, lead root-cause analyses, and help develop corrective actions while partnering with leadership to ensure timely, accurate