Director, Enterprise Compliance Corrections

Centene Corporation

10d•Remote

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: Manages teams within the Compliance Corrections department responsible for remediation and reporting activities to ensure successful resolution of identified non-compliance with Medicaid, Medicare, Marketplace, and Commercial regulatory requirements, contractual obligations and Company policies and procedures. Supports the internal and external corrective action plan lifecycle and related reporting. Partners with Product Compliance teams, Shared Services leadership, and Health Plan leaders to ensure successful and timely remediation of identified compliance issues. Supports the remediation of compliance issues across all Centene lines of business. Facilitates collaboration between compliance and business stakeholders to ensure timely completion of corrective action plans as well as escalation of issues with identified barriers to remediation. Assists in the development of Board and Sr. Management reporting of key metrics and activities of the Corrections team. Coordinates the oversight of corrective action plans for remediation of internally and externally identified deficiencies and ensures that remediation activities are effective and timely executed. Employs corrections definitions, processes and tools designed to effectively remediate compliance issues in a timely manner, ensure timely escalation and sustainable resolution. Manages and develops direct reports who include other supervisory personnel and/or exempt individual contributors. 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. Participates in mock and actual CMS audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of CMS Program Audit readiness, including but not limited to universes, mock webinars, collaboration with internal subject matter experts (Regulatory Compliance and Internal Audit). Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws. Performs other duties as assigned Complies with all policies and standards.

Requirements

Bachelor's Degree Business Administration, Public Policy, Public Health, or Health Administration or related field, or equivalent experience required
5+ years experience in compliance for a managed care or health insurance company required
4+ years management experience preferred

Nice To Haves

Master's Degree Business Administration, Public Policy, Public Health, or Health Administration or related field preferred
7+ years experience preferred
HCCA certification (CHC) or equivalent preferred

Responsibilities

Manages teams within the Compliance Corrections department responsible for remediation and reporting activities to ensure successful resolution of identified non-compliance with Medicaid, Medicare, Marketplace, and Commercial regulatory requirements, contractual obligations and Company policies and procedures.
Supports the internal and external corrective action plan lifecycle and related reporting.
Partners with Product Compliance teams, Shared Services leadership, and Health Plan leaders to ensure successful and timely remediation of identified compliance issues.
Supports the remediation of compliance issues across all Centene lines of business.
Facilitates collaboration between compliance and business stakeholders to ensure timely completion of corrective action plans as well as escalation of issues with identified barriers to remediation.
Assists in the development of Board and Sr. Management reporting of key metrics and activities of the Corrections team.
Coordinates the oversight of corrective action plans for remediation of internally and externally identified deficiencies and ensures that remediation activities are effective and timely executed.
Employs corrections definitions, processes and tools designed to effectively remediate compliance issues in a timely manner, ensure timely escalation and sustainable resolution.
Manages and develops direct reports who include other supervisory personnel and/or exempt individual contributors.
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.
Participates in mock and actual CMS audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of CMS Program Audit readiness, including but not limited to universes, mock webinars, collaboration with internal subject matter experts (Regulatory Compliance and Internal Audit).
Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws.
Performs other duties as assigned Complies with all policies and standards.