Senior Compliance Administrator, Medicare Claims & Payment Integrity at Centene

Overview

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.
• Position Purpose: 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.
• This role partners closely with the Sr.
• Manager, Medicare Compliance Advisory, to ensure accurate interpretation of CMS requirements, timely completion of assignments, and consistent documentation of compliance risks, trends, and corrective actions.
• 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.
• Conduct regulatory research and analysis to support business inquiries, compliance advisory opinions, and implementation activities.
• 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.

Benefits

• package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
• Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law , including full-time or part-time status.
• Total compensation may also include additional forms of incentives.

Benefits

• may be subject to program eligibility.
• 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.
• Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act