Senior Medicare Compliance Advisor

Centene Corporation; Georgia; Hybride; USD 95 000 - 135 000; Plein temps

Résumé du poste

Centene Corporation is seeking a Medicare Compliance Advisory specialist to support day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements. You will provide regulatory guidance, conduct research, track issues, and support audit readiness across the organization.

This role emphasizes translating complex federal and state regulations into actionable guidance for stakeholders, developing communications, and assisting with corrective actions to ensure

Qualifications

• Bachelor’s degree or equivalent experience in healthcare administration, public health, or policy.
• 5+ years in Compliance, regulatory, operations, or risk management in a regulated industry.
• ~4+ years Compliance advisory experience including regulatory research, drafting guidance, risk assessment, and monitoring.
• ~ Foundational knowledge of Medicare regulations, including CMS guidance and compliance expectations (e.g., Parts C & D).
• ~ Certified in Healthcare Compliance (CHC) preferred; familiarity with CMS audit protocols preferred.

Responsabilités

• Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
• Interprets and translates federal, state, and contractual requirements into clear, actionable compliance guidance for business stakeholders, ensuring consistent understanding and application across operations.
• Develops and coordinates regulatory communications, including responses to inquiries, issue summaries, and disclosures, while serving as a liaison with regulators as appropriate.
• Supports the preparation, validation, and submission of regulatory reports, attestations, and filings, ensuring accuracy, completeness, and timeliness of all deliverables.
• Proactively identifies compliance risks and evaluates business processes to assess exposure, provide risk stratification, and recommend mitigation strategies.
• Leads or supports issue identification, root cause analysis, and development of corrective action plans to ensure effective and compliant resolution of identified gaps.
• Provides subject matter expertise to audit and monitoring activities, including supporting audit scope development, testing strategies, and ongoing compliance oversight.
• Partners with internal and external stakeholders to support audit execution, regulatory reviews, and ongoing audit readiness activities.
• Evaluates remediation plans and validates corrective actions to ensure sustainable and compliant resolution of issues, including assessment of regulatory reporting or disclosure requirements.
• Contributes to the development and delivery of compliance training, while mentoring stakeholders on regulatory requirements, policies, and best practices.
• Reviews and assesses policies, procedures, and business processes to ensure alignment with regulatory and contractual requirements and organizational standards.
• Leads or contributes to cross‑functional initiatives to enhance compliance processes, drive operational efficiency, and align compliance activities with organizational objectives.
• Monitors regulatory developments and industry trends to identify emerging risks and support continuous improvement of compliance programs.
• Collaborates with compliance, legal, audit, and operational partners to ensure coordinated execution of compliance activities across business areas.
• Complies with all policies and standards.

Connaissances

Compliance

Regulatory research

Drafting compliance guidance

Auditing / monitoring

Risk assessment

Formation

Bachelor’s degree or equivalent experience

Description du poste

Centene Corporation is seeking a Medicare Compliance Advisory specialist to support day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements. You will provide regulatory guidance, conduct research, track issues, and support audit readiness across the organization.

This role emphasizes translating complex federal and state regulations into actionable guidance for stakeholders, developing communications, and assisting with corrective actions to ensure