Senior Medicare Compliance Advisor - Audit & Guidance

Centene Corporation; Madison (WI); Hybrid; USD 110,000 - 150,000; Full time

Benefits offered by this job

Health insurance

401K

Tuition reimbursement

Paid time off

Flexible work arrangements

Job summary

Centene Corporation is seeking a Manager, Medicare Compliance Advisory to lead and execute the day-to-day Medicare compliance program in alignment with CMS requirements. You will translate federal and state regulations into clear guidance for business stakeholders and support audit readiness and regulatory reporting.

The role emphasizes risk identification, remediation validation, and collaboration with internal/external regulators to ensure sustained compliant operations within a fast-paced

Qualifications

• Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required.
• 5+ years Compliance, regulatory, operations, or risk management within a regulated industry (e.g., healthcare, managed care, insurance, or public sector).
• ~4+ years Compliance advisory experience to include regulatory research and drafting compliance guidance, assessing risk, issue tracking, auditing / monitoring, and overseeing the development and implementation of correction action plans required.
• ~2+ years experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.
• ~Foundational knowledge of Medicare regulations, including CMS guidance and compliance expectations (e.g., Parts C & D).
• Ability to manage multiple assignments and meet deadlines in a fast-paced environment.
• Certified in Healthcare Compliance (CHC) preferred.
• Familiarity with CMS audit protocols, program audits, or monitoring activities preferred.
• RN, LPN, Pharmacist, CPhT, Case Management) preferred.

Responsibilities

• Serves as an individual contributor and subject matter expert responsible for supporting the day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements and applicable federal and state regulations.
• Provides trusted advisory support to business and compliance leadership by providing regulatory guidance, conducting research and analysis, tracking issues, contributing to audit readiness and supporting compliance workplan activities.
• Executes 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 internal stakeholders and external regulators as appropriate.
• Supports the preparation, validation, and submission of regulatory reports, attestations, and filings, ensuring accuracy, completeness, and timeliness of all deliverables.

Job description

Centene Corporation is seeking a Manager, Medicare Compliance Advisory to lead and execute the day-to-day Medicare compliance program in alignment with CMS requirements. You will translate federal and state regulations into clear guidance for business stakeholders and support audit readiness and regulatory reporting.

The role emphasizes risk identification, remediation validation, and collaboration with internal/external regulators to ensure sustained compliant operations within a fast-paced