Senior Compliance Analyst, Duals Audit
About the position You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. Position Purpose: Partners with leadership in maintaining Centene Corporation's Compliance with Duals (D-SNP) Program requirements. Provide regulatory interpretation, perform compliance reporting, lead special projects, and develop and implement compliance auditing and monitoring strategies for the D-SNPs. Responds to external audit requests for information required by the organization for its Duals and SMAC regulatory filings. Manages Duals (and Medicare with D-DSNP specific or separate) compliance reporting responsibilities and respond to inquiries from state and federal regulatory agencies. Leads Duals compliance projects or implementations. Reviews and synthesizes Duals regulatory requirements and create policy and/or position statements. Partners with leadership to manage annual SMAC assessment and tracking of caps. Communicate Duals (state and federal) requirements to internal and external clients. Provides development guidance and leads the identification, implementation, and maintenance of Duals and overlapping Medicare compliance policies, procedures and work instructions. Leads the identification, analysis, and resolution of Duals compliance issues. Maintains and reviews D-SNP regulatory documentation necessary to maintain corporate standards. Partners with leadership in developing, producing and conducting Duals compliance training programs. Perform periodic compliance audits, risk assessments and conducts related to ongoing Duals compliance monitoring activities. Serves as a company-wide resource and liaison on Duals policies, SMAC items and provisions, communications, workflow, and quality improvements initiatives. Performs other duties as assigned. Complies with all policies and standards.
Responsibilities
- Partners with leadership in maintaining Centene Corporation's Compliance with Duals (D-SNP) Program requirements.
- Provide regulatory interpretation
- Perform compliance reporting
- Lead special projects
- Develop and implement compliance auditing and monitoring strategies for the D-SNPs.
- Responds to external audit requests for information required by the organization for its Duals and SMAC regulatory filings.
- Manages Duals (and Medicare with D-DSNP specific or separate) compliance reporting responsibilities and respond to inquiries from state and federal regulatory agencies.
- Leads Duals compliance projects or implementations.
- Reviews and synthesizes Duals regulatory requirements and create policy and/or position statements.
- Partners with leadership to manage annual SMAC assessment and tracking of caps.
- Communicate Duals (state and federal) requirements to internal and external clients.
- Provides development guidance and leads the identification, implementation, and maintenance of Duals and overlapping Medicare compliance policies, procedures and work instructions.
- Leads the identification, analysis, and resolution of Duals compliance issues.
- Maintains and reviews D-SNP regulatory documentation necessary to maintain corporate standards.
- Partners with leadership in developing, producing and conducting Duals compliance training programs.
- Perform periodic compliance audits, risk assessments and conducts related to ongoing Duals compliance monitoring activities.
- Serves as a company-wide resource and liaison on Duals policies, SMAC items and provisions, communications, workflow, and quality improvements initiatives.
- Performs other duties as assigned.
- Complies with all policies and standards.
Requirements
- Bachelor's Degree Law or related field; or, equivalent experience required
- 4+ years Compliance and/or regulatory affairs required
- Experience in project management with working knowledge of laws and/or regulations in area of compliance, in particular Medicare, D-SNP, and state regulations required
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
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