Director overseeing regulatory compliance operations for Centene, ensuring adherence to laws and regulations. Collaborating with teams to implement compliance strategies and manage Medicare compliance.
Responsibilities
Direct and oversee regulatory compliance operations to ensure fully compliance with all applicable laws and regulations for assigned products/services
Oversee, administer, and implement various aspects of the Medicare Compliance program, including HPMS communication/regulation
Ability to research and apply CMS, DOI, OIG, and HIPPA regulations to create processes and strategies while ensuring corporate compliance
Coordinate and document Centene responses to CMS Request for Information/Response
Provide guidance to various departments regarding compliance issues and ensure 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
Partner with various departments to ensure that state and/or federal regulatory requirements are communicated and met
Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures
Ensure all Medicare products and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities
Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations; ensure policies and procedures are updated according to CMS/contract requirements
Requirements
Bachelor's degree in Business Administration, Health Care Administration, related field or equivalent experience
7+ years of regulatory, compliance, operations, or related experience, preferably in a health care environment
Advanced degree preferred
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
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