Senior Medicare Compliance Advisor | Risk & Audit Leader

Centene Corporation; Lorida (FL); Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Remote/hybrid work options

Comprehensive benefits

Job summary

Centene Corporation is seeking an experienced Medicare Compliance Advisor to serve as a subject matter expert and drive day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements. You will interpret federal and state regulations, advise business stakeholders, and support audit readiness across operations.

The role requires strong regulatory research, issue tracking, and corrective action development, with collaboration across legal, compliance, and

Qualifications

• Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required.
• Master’s Degree or Juris Doctor preferred.
• 5+ years Compliance, regulatory, operations, or risk management within a regulated industry.

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

Regulatory interpretation

CMS requirements knowledge

Regulatory research

Issue tracking

Audit readiness

Training delivery

Stakeholder collaboration

Education

Bachelor's degree in healthcare administration or related field

Master’s or JD preferred

Job description

Centene Corporation is seeking an experienced Medicare Compliance Advisor to serve as a subject matter expert and drive day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements. You will interpret federal and state regulations, advise business stakeholders, and support audit readiness across operations.

The role requires strong regulatory research, issue tracking, and corrective action development, with collaboration across legal, compliance, and