Senior Compliance Analyst, Duals (D-SNP) Products

Cenetene Corporation; Raleigh (NC); Remote; USD 68,000 - 124,000; Full time

Job summary

An established industry player is seeking a Compliance Manager to oversee regulatory compliance for its Duals (D-SNP) Program. This pivotal role involves managing compliance reporting, leading special projects, and developing policies to ensure adherence to state and federal regulations. The ideal candidate will have a strong background in compliance and regulatory affairs, along with experience in project management. The company offers a flexible work environment, competitive pay, and a comprehensive benefits package, making this an exciting opportunity for professionals looking to make a significant impact in the healthcare sector.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• 4+ years in Compliance and/or regulatory affairs required.
• Experience with Medicare, D-SNP, and state regulations.

Responsibilities

• Manage compliance reporting and respond to regulatory inquiries.
• Lead compliance projects and conduct audits for D-SNPs.
• Develop and implement compliance policies and training programs.

Skills

Compliance Management

Regulatory Affairs

Project Management

Policy Development

Risk Assessment

Education

Bachelor's Degree in Law 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:**

Partners with leadership in maintaining Centene Corporation's Compliance with Duals (D-SNP) Program requirements. Provide regulatory interpretation, perform compliance reporting, lead special projects, and develop and implement compliance auditing and monitoring strategies for the D-SNPs.

+ Responds to external requests for information required by the organization for its Duals and SMAC regulatory filings.

+ Manages Duals (and Medicare with D-DSNP specific or separate) compliance reporting responsibilities and respond to inquiries from state and federal regulatory agencies.

+ Leads Duals compliance projects or implementations.

+ Reviews and synthesizes Duals regulatory requirements and create policy and/or position statements.

+ Partners with leadership to manage annual SMAC assessment and tracking of caps.

+ Communicate Duals (state and federal) requirements to internal and external clients.

+ Provides development guidance and leads the identification, implementation, and maintenance of Duals and overlapping Medicare compliance policies, procedures and work instructions.

+ Leads the identification, analysis, and resolution of Duals compliance issues.

+ Maintains and reviews D-SNP regulatory documentation necessary to maintain corporate standards.

+ Partners with leadership in developing, producing and conducting Duals compliance training programs.

+ Perform periodic compliance audits, risk assessments and conducts related to ongoing Duals compliance monitoring activities.

+ Partners with Duals Manager and health plans in managing relationships with regulatory agencies and seek to confirmation and clarification of D-SNP requirements and implementations where needed.

+ Performs interim Duals Compliance manager responsibilities to include supporting the health plan compliance officer with D-SNP specific responsibilities. Serve as a company-wide resource and liaison on policies, contract issues and provisions, communications, workflow, and quality improvements initiatives.

+ Serves as a company-wide resource and liaison on Duals policies, SMAC items and provisions, communications, workflow, and quality improvements initiatives.

+ Performs other duties as assigned.

+ Complies with all policies and standards.

**Education/Experience:**

+ Bachelor's Degree Law or related field; or, equivalent experience required

+ 4+ years Compliance and/or regulatory affairs required

+ Experience in project management with working knowledge of laws and/or regulations in area of compliance, in particular Medicare, D-SNP, and state regulations required

Pay Range: $68,700.00 - $123,700.00 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