Senior Compliance Administrator, Medicare Claims – Payment Integrity

🕒 5 dias atrás

🐊 Florida, Illinois, +1 estados a mais – Remoto

🐊 Florida – Remote 🌽 Illinois – Remote 🏰 Missouri – Remote

💵 $87.700 - $157.800 / ano

⏰ Tempo Integral

🟠 Sênior

🚔 Conformidade

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Centene Corporation

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1984

⚕️ Seguro de Saúde

🤝 Sem Fins Lucrativos

🌍 Impacto Social

Healthcare Insurance • Non-profit • Social Impact

Centene Corporation é uma provedora líder de serviços de saúde patrocinados pelo governo, especializada em oferecer soluções de saúde acessíveis e de alta qualidade. Há mais de 40 anos, a Centene tem se dedicado a transformar a saúde das comunidades, ampliando o acesso a Medicaid, Medicare e ao Health Insurance Marketplace, além de atender comunidades militares por meio do programa TRICARE. Como a maior organização de managed care do Medicaid e participante-chave no Marketplace, a Centene enfatiza a entrega de cuidados de saúde com foco local, combinada a parcerias sólidas com organizações sem fins lucrativos para atender às necessidades únicas de seus membros. A Centene também é comprometida com sustentabilidade corporativa e responsabilidade social, priorizando a gestão ambiental e a governança ética para promover o bem-estar das comunidades que atende.

Descrição

• 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 • Partners closely with the Sr. Manager, Medicare Compliance Advisory • Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA • Execute assignments, ensuring timely, accurate, and well-documented completion of deliverables • Serve as a compliance advisor and subject matter resource for Medicare programs by interpreting CMS regulations and guidance and translating requirements into clear, actionable business input; as well as advising leadership on compliance impact and implementation needs • Support intake, tracking, and resolution of compliance issues, including documenting findings, assessing risk, and recommending corrective actions • Contribute to monitoring and oversight activities by identifying regulatory risks and trends and supporting resolution of identified issues • Prepare draft responses and supporting materials for regulatory inquiries, audits, data requests, and internal compliance reviews • Maintain accurate and complete documentation of compliance activities, including issue logs, regulatory references, self-disclosures and supporting evidence • Collaborate with cross-functional business partners to clarify regulatory requirements and support the implementation of compliant processes • Escalate compliance risks, gaps, or delays in a timely manner to support effective risk management and decision-making • Contribute to audit readiness by supporting documentation, process validation, and issue resolution activities • Identify process improvement opportunities and support initiatives to enhance compliance controls, standardization, and operational efficiency • Support compliance training and education initiatives, ensuring awareness of Medicare regulatory program requirements, standards of conduct, and reporting obligations.

🎯 Requisitos

• 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) • Demonstrated experience interpreting and applying complex regulatory frameworks and compliance program requirements within a regulated environment into clear, actionable guidance for business stakeholders required • Experience leading cross-functional initiatives or large-scale compliance efforts, required • Experience conducting risk assessments, analyzing data, and applying structured problem-solving approaches to identify compliance risks and recommend mitigation strategies required • Experience effectively communicating with and managing relationships across stakeholders, including presenting complex compliance concepts to diverse audiences required • Demonstrated experience influencing cross-functional partners and driving outcomes in a matrixed environment without direct authority required • 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)

🏖️ Benefícios

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules