Senior Director, Compliance Advisory (Medicare)

Cenetene Corporation; Austin (TX); Remote; USD 145,000 - 269,000; Full time

Job summary

An innovative organization is seeking a Compliance Officer to ensure regulatory adherence for Medicare and Medicaid products. This role involves overseeing compliance projects, developing public policy relationships, and advising management on regulatory issues. The ideal candidate will have extensive experience in compliance and healthcare, with a strong focus on Medicare regulations. Join a team that values workplace flexibility and offers a comprehensive benefits package, including competitive pay and opportunities for professional growth. This is a chance to make a significant impact in the health sector while working in a supportive environment.

Benefits

Health Insurance

401K Plan

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• 10+ years of compliance experience, preferably in healthcare.
• Experience with federal and state regulatory agencies preferred.

Responsibilities

• Ensure regulatory compliance with federal and state legal requirements.
• Oversee and implement aspects of the Medicare Compliance program.
• Develop policies to comply with federal and state regulations.

Skills

Regulatory Compliance

Medicare Regulations

Public Policy Development

Risk Management

Contract Implementation

Education

Bachelor’s Degree in Business Administration

Master’s Degree or Juris Doctor

Tools

Compliance Software

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 Continental United States.

Position Purpose:

Ensure regulatory compliance with federal and state legal and regulatory requirements related to Medicare compliance and HPMS/CMS regulations.

1. Oversee and monitor various cross-functional projects implemented by management.
2. Develop strategic relationships to assist with the development of public policy concerning federal managed care regulations and initiatives.
3. Represent senior management at various committees, meetings, and seminars.
4. Communicate with CMS to ensure timely completion of CMS requirements and expectations.
5. Ensure all Medicare and Medicaid products and services are tested for compliance with program regulations, insurance regulations, and other regulatory requirements.
6. Maintain and track laws, regulations, contract documentation, amendments, and compliance measures.
7. Develop policies, procedures, and processes to comply with federal and state regulations.
8. Collaborate with operational departments to ensure policies and procedures are developed and modified to meet regulatory standards, providing guidance on regulatory and contract language.
9. Oversee and implement aspects of the Medicare Compliance program.
10. Advise departments on compliance issues and the implementation of new requirements.
11. Identify, evaluate, and analyze the impact of CMS and Medicare regulatory issues, advising management accordingly.
12. Report all Medicare and MMP risks following risk reporting policies.
13. Provide ethics, compliance, risk management, FWA, privacy, and security training for employees and contractors.
14. Partner with departments to ensure communication and compliance with regulatory requirements.
15. Perform other duties as assigned and ensure compliance with all policies and standards.

Education/Experience:

1. Bachelor’s degree in Business Administration, Healthcare Administration, or a related field; Master’s Degree or Juris Doctor preferred.
2. 10+ years of compliance experience, preferably in healthcare.
3. 5+ years of Medicare and/or Managed Care experience.
4. 1+ years of overseeing contract implementation.
5. Experience interacting with federal and state regulatory agencies preferred.
6. Experience with Medicare, CMS regulations, and software tools 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 flexible work arrangements (remote, hybrid, field, or office schedules). Actual pay will be based on skills, experience, education, and other factors. Total compensation may include additional incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.