Compliance Corrections Specialist

Centene Corporation•Remote-MO, MO

2d•$56,200 - $101,000•Remote

About The Position

Participates in the oversight of Centene's and/or its third parties/subcontractor's corporate ethics and compliance program, and ongoing oversight and analysis of external and internal corrective actions. Responsibilities include conducting focused reviews and audit, oversight, and monitoring of activities to assess compliance with Centene's contractual and regulatory requirements; collaborates with business owners and/or third parties/subcontractors to drive remediation and assist Centene and third parties/subcontractors to maintain integrity through oversight and monitoring and in meeting Government-sponsored health care program requirements. Intakes and triages compliance issues based on defined risk criteria and signs out to other team members as needed. Collaborates with compliance and business stakeholders to ensure adequate root cause analysis and development of corrective actions plans to effectively address non-compliance. Reviews and oversees progress towards remediation and documented key milestones in GRC tool. Identifies issues that require escalation and ensures they are addressed timely through established paths and processes. Conducts review of evidence to address root cause of issue and facilitate timely closure of issues. Supports corrections reporting that provides meaningful trend analysis for business stakeholders and senior leadership on new, in progress and closed issues as well as regulatory sanctions. Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs. Performs other duties as assigned Complies with all policies and standards

Requirements

Bachelor's Degree Managed Care/Health Insurance or related field; or equivalent experience required
3+ years years of experience in Managed Care, Health Care, Health Insurance or related field required
1+ years experience in project oversight type role with demonstrated ability to drive implementation and influence others preferred
1+ years experience in reading, analyzing, and interpreting State and Federal laws, rules and regulations preferred
1+ years experience in State Medicaid or Federal managed care compliance preferred

Nice To Haves

Certified in HealthCare Compliance (CHC) preferred

Responsibilities

Conducting focused reviews and audit, oversight, and monitoring of activities to assess compliance with Centene's contractual and regulatory requirements
Collaborates with business owners and/or third parties/subcontractors to drive remediation and assist Centene and third parties/subcontractors to maintain integrity through oversight and monitoring and in meeting Government-sponsored health care program requirements
Intakes and triages compliance issues based on defined risk criteria and signs out to other team members as needed
Collaborates with compliance and business stakeholders to ensure adequate root cause analysis and development of corrective actions plans to effectively address non-compliance
Reviews and oversees progress towards remediation and documented key milestones in GRC tool
Identifies issues that require escalation and ensures they are addressed timely through established paths and processes
Conducts review of evidence to address root cause of issue and facilitate timely closure of issues
Supports corrections reporting that provides meaningful trend analysis for business stakeholders and senior leadership on new, in progress and closed issues as well as regulatory sanctions
Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs
Performs other duties as assigned
Complies with all policies and standards