Description: Position Purpose: Manage and implement strategies to ensure successful maintenance and implementation of compliance programs that meet regulatory requirements for assigned products across the entire company
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 various compliance measures
Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations
Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language
Conduct compliance audits, develop and implement corrective action plans
Perform plan risk assessments and report emerging trends, deficiencies and variances; report findings to other departments and teams as appropriate
Provide required Ethics, Compliance, Risk Management, FWA, privacy, and security training for existing and new employees and as required non-employees
Monitor Commercial product risks in accordance with the risk reporting policies
Manage Benefit Filings and entity licensures for all products to ensure compliance with state and federal regulatory requirements
Work in collaboration with Marketing teams to monitor Sales & Marketing representatives and materials used in advertisements
Medicare (additional responsibilities):
Monitor the FDR oversight program to ensure all Medicare and MMP plans are conducting the appropriate oversight in a timely manner
Report all Medicare and Medicaid product risks in accordance with the risk reporting policies
Partner with various departments as the local executive responsible for ensuring that state and/or federal regulatory requirements relating to business continuity and disaster recovery are communicated and met
Education/Experience: Bachelors degree in related field or equivalent experience. Master's or Juris Doctorate degree preferred. 4+ years of compliance experience, preferably in a healthcare environment with at least 2+ years of Medicaid, Medicare or Commercial Managed Care experience. Previous experience demonstrating effective interaction with federal and state regulatory agencies in a managed care or insurance environment preferred.
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.
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.