Remote Medicare Compliance Advisor - Clinical & Audit

Centene Corporation; Charlotte (NC); Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Job summary

Centene Corporation seeks a Medicare Compliance Advisor to support day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements. You will translate complex federal/state requirements into actionable guidance for business teams and assist with regulatory reports and audits.

The role partners with senior leadership to ensure timely, accurate documentation of compliance risks, trends, and corrective actions, while advancing audit readiness and program

Qualifications

• Bachelor's degree required. Master's degree or JD preferred.
• 5+ years in Compliance, regulatory, operations, or risk management in a regulated industry.
• 4+ years Compliance advisory experience including regulatory research, drafting guidance, risk assessments, and audit/monitoring.
• 2+ years supporting managed care, Medicare Advantage/Part D, or DSNP programs.
• Foundational knowledge of Medicare regulations (CMS guidance and expectations).
• Certified in Healthcare Compliance (CHC) preferred.

Responsibilities

• Execute the Medicare Compliance Program in alignment with CMS and regulations; prevent, detect, and correct noncompliance and FWA.
• Translate federal, state, and contractual requirements into clear, actionable compliance guidance for stakeholders.
• Develop regulatory communications and disclosures; liaise with regulators as appropriate.
• Assist in preparation, validation, and submission of regulatory reports and attestations.
• Identify compliance risks, evaluate processes, and propose mitigation strategies.
• Lead or support root cause analyses and corrective action plans for gaps.
• Support audit scope development, testing strategies, and ongoing compliance oversight.
• Collaborate with stakeholders to support audits, regulatory reviews, and readiness activities.
• Evaluate remediation plans to ensure sustainable corrective actions and regulatory reporting requirements.
• Contribute to compliance training and mentor stakeholders on regulatory requirements and best practices.
• Review policies and procedures to ensure alignment with regulatory and contractual requirements.
• Lead cross-functional initiatives to enhance compliance processes and efficiency.
• Monitor regulatory developments and industry trends to identify emerging risks.

Skills

Regulatory research

Policy drafting

Issue tracking

Auditing/monitoring

Cross-functional collaboration

Communication skills

Education

Bachelor's degree in healthcare administration or related field

Master's degree or JD preferred

Job description

Centene Corporation seeks a Medicare Compliance Advisor to support day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements. You will translate complex federal/state requirements into actionable guidance for business teams and assist with regulatory reports and audits.

The role partners with senior leadership to ensure timely, accurate documentation of compliance risks, trends, and corrective actions, while advancing audit readiness and program