Position Purpose: 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. This role partners closely with the Sr. Manager, Medicare Compliance Advisory, to ensure accurate interpretation of CMS requirements, timely completion of assignments, and consistent documentation of compliance risks, trends, and corrective actions.
- 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.
Education/Experience:
- 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 (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)
- 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, CPhT, Case Management) preferred.
Pay Range: $87,700.00 - $157,800.00 per year
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
.jpg?1761221989)
