Senior Compliance Administrator, Medicare Claims – Payment Integrity

🔥 0 minutes ago

🐊 Florida, Illinois, +1 more states – Remote

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

💵 $87.7k - $157.8k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Healthcare Insurance • Non-profit • Social Impact

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 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.

🎯 Requirements

• 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)

🏖️ Benefits

• 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