Senior Director, Auditing, Monitoring & Oversight (Medicare)

Cenetene Corporation; Raleigh (NC); Remote; USD 145,000 - 269,000; Full time

Job summary

An established industry player is seeking a strategic leader to oversee compliance in the health sector. This role involves managing compliance with Medicare regulations, conducting risk assessments, and ensuring effective oversight of compliance issues. The ideal candidate will have extensive experience in compliance management, a strong understanding of regulatory requirements, and the ability to lead teams effectively. With a focus on workplace flexibility, this organization offers a competitive benefits package and the opportunity to make a significant impact on the health of communities across the nation.

Benefits

Health Insurance

401K Plan

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• 10+ years of compliance experience in managed care or health insurance.
• Strong leadership and management skills with a focus on compliance.

Responsibilities

• Oversee compliance with Medicare regulations and laws.
• Manage team conducting compliance reviews and risk assessments.
• Develop metrics and oversight tools for compliance monitoring.

Skills

Compliance Management

Risk Assessment

Regulatory Knowledge

Leadership

Audit Coordination

Education

Bachelor's Degree in Business Administration

CPA or equivalent

10+ years Compliance experience

7+ years Management experience

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 role will have the flexibility to work remotely anywhere in the United States.

**Position Purpose:**

Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Medicare line of business, which includes implementation of elements of an effective compliance program related to specific operational areas. Oversee the development of risk assessments and oversight and monitoring work plans pertaining to those areas. Partners with business areas to ensure effective prevention, detection and correction of compliance issues.

+ Establish a process for overseeing compliance with regulations and laws related to Medicare requirements

+ Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language

+ Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues

+ Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate

+ Oversee team responsible for monitoring against regulatory requirements ensures sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns

+ Develops and monitors metrics and other oversight tools that indicate business area compliance

+ Provides compliance guidance, direction and compliance risk assessment to assigned business partners

+ Manages and develops direct reports who include other management or supervisory personnel and/or exempt individual contributors

+ Plan and collaborate with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches

+ Set operational priorities including the development and maintenance of effective oversight activities and prioritization of work

+ Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee

+ Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance to meet the requirements of Government-sponsored health care programs

+ Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness

+ Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws

+ Makes decisions on complex issues regarding technical approach for project components and can work without significant direction

+ Performs other duties as assigned.

+ Comply with all policies and standards.

**Education/Experience:**

+ Bachelor's Degree Business Administration, Public Policy, Public Health, Health Administration or related field; or equivalent experience required

+ CPA, CISA, JD, MHA, MBA, MIS preferred

+ 10+ years Compliance for a managed care or health insurance company or equivalent experience required

+ 7+ years Management experience preferred

**Licenses/Certifications:**

+ HCCA certification (CHC) or equivalent preferred

Pay Range: $145,100.00 - $268,800.00 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