Senior Director, Compliance Advisory (Medicare)

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Ensure regulatory compliance with federal and state legal and regulatory requirements as it relates to Medicare compliance and HPMS/CMS regulations.

• Oversee and monitor various of cross-functional projects implemented by management.
• Develop strategic relationships to assist with the development of public policy concerning federal managed care regulations and initiatives.
• Represent senior management at various committees, meetings, and seminars.
• Communicate with CMS ensure timely completion of CMS requirements and expectations.
• Ensure all Medicare and Medicaid product and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities.
• Maintain and track laws and regulations, contract documentations, amendments, and carious compliance measures.
• Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations.
• Work with Operational Departments to ensure that policies, procedures, and processes are developed and modified to comply with state regulatory standards. Provide guidance to various departments with respect to regulatory and contract language.
• Oversee, administer, and implement various aspects of the Medicare Compliance program.
• Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language.
• Identify, evaluate, and analyze the impact of CMS and Medicare regulatory issues and advise management concerning impact.
• Report all Medicare and MMP risks in accordance with the risk reporting policies.
• Provide required Ethics, Compliance, Risk Management, FWA, privacy, and security training for existing and new employees and as required non-employees such as contracted temporary staff, and FDR’s as needed.
• Partner with various departments to ensure that state and/or federal regulatory requirements are communicated and met.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Bachelor’s degree Business Administration, Healthcare Administration, related field or equivalent experience. Master's Degree Business Administration, Healthcare Administration, or related field preferred. Pre-Law Degree or Juris Doctor preferred.
• 7+ years Compliance, preferably in healthcare environment, required.
• 5+ years Medicare and/or Managed Care, required.
• 1+ years Overseeing implementation of contract requirements, required.
• 1+ years Interaction and communication with federal and state regulatory agencies, preferred.
• 1+ years Medicare, CMS regulations and software application tools, preferred.

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.  Total compensation may also include additional forms of incentives.

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