Senior Compliance Administrator, Medicare Claims – Payment Integrity

🕒 il y a 7 jours

🐊 Florida, Illinois, +1 états de plus – Distant

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

💵 $87 700 - $157 800 / an

⏰ Temps Plein

🟠 Senior

🚔 Conformité

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Centene Corporation

Site WebLinkedInTous les Emplois

10 000+ employés

Fondée en 1984

⚕️ Assurance santé

🤝 À but non lucratif

🌍 Impact social

Healthcare Insurance • Non-profit • Social Impact

La société Centene Corporation est un leader dans la fourniture de services de santé subventionnés par le gouvernement, spécialisée dans la délivrance de solutions de santé abordables et de haute qualité. Depuis plus de 40 ans, Centene s’est concentrée sur la transformation de la santé des communautés en élargissant l'accès aux services de Medicaid, Medicare, et au marché de l'assurance santé, tout en servant les communautés militaires à travers le programme TRICARE. En tant que plus grande organisation de gestion des soins Medicaid et un acteur clé du marché, Centene met l'accent sur une prestation de soins de santé localisée combinée à des partenariats solides avec des organisations à but non lucratif pour répondre aux besoins uniques de ses membres. Centene s’engage également pour le développement durable et la responsabilité sociale des entreprises, en privilégiant la gestion environnementale et la gouvernance éthique afin d'améliorer le bien-être des communautés qu’elle dessert.

Description

• 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.

🎯 Exigences

• 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)

🏖️ Avantages

• 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