Senior Medicare Compliance Advisor – Remote/Hybrid

Centene Corporation; New York (NY); Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off & holidays

Remote/hybrid/field or office work S</

Job summary

Centene Corporation in New York is seeking an experienced Medicare Compliance Advisory professional to execute the CMS-aligned program, translate requirements for business teams, and support regulatory reporting. The role partners with leadership to identify risks, develop corrective actions, and advance audit readiness while mentoring stakeholders on CMS expectations.

The position emphasizes collaboration, regulatory liaison work, and ongoing training to ensure sustainable, compliant operations

Qualifications

• Bachelor's degree in a related field or equivalent experience required; Master's Degree or Juris Doctor preferred.
• 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.
• 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).
• Strong written and verbal communication skills.
• Strong analytical, organizational and documentation skills with attention to detail.
• 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.
• Experience working in a matrixed or cross-functional environment preferred.
• Related / relevant licensure (e.g. RN, LPN, Pharmacist, Case Management) preferred.

Responsibilities

• 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 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.
• 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.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Communication skills

Analytical skills

Organization skills

Documentation skills

Multitasking

CHC certification

Education

Bachelor's degree

Master's degree

Juris Doctor

RN/LPN/Pharmacist licensure

CHC certification

Job description

Centene Corporation in New York is seeking an experienced Medicare Compliance Advisory professional to execute the CMS-aligned program, translate requirements for business teams, and support regulatory reporting. The role partners with leadership to identify risks, develop corrective actions, and advance audit readiness while mentoring stakeholders on CMS expectations.

The position emphasizes collaboration, regulatory liaison work, and ongoing training to ensure sustainable, compliant operations