Senior Compliance Administrator, Medicare Claims & Payment Integrity

Centene Corporation•Remote-MO, MO

1d•$87,700 - $157,800•Hybrid

About The Position

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.

Requirements

Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required.
5+ years Compliance, regulatory, operations, or risk management within a regulated industry (e.g., healthcare, managed care, insurance, or public sector).
Demonstrated experience interpreting and applying complex regulatory frameworks and compliance program requirements within a regulated environment into clear, actionable guidance for business stakeholders required.
Experience leading cross-functional initiatives or large-scale compliance efforts, required.
Experience conducting risk assessments, analyzing data, and applying structured problem-solving approaches to identify compliance risks and recommend mitigation strategies required.
Experience effectively communicating with and managing relationships across stakeholders, including presenting complex compliance concepts to diverse audiences required.
Demonstrated experience influencing cross-functional partners and driving outcomes in a matrixed environment without direct authority required.
Experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.
Foundational knowledge of Medicare regulations, including CMS guidance and compliance expectations (e.g., Parts C & D).

Nice To Haves

Master's Degree or Juris Doctor preferred.
Certified in Healthcare Compliance (CHC) preferred.
Familiarity with CMS audit protocols, program audits, or monitoring activities preferred.
Experience working in a matrixed or cross-functional environment preferred.
RN, LPN, Pharmacist, CPhT, Case Management preferred.

Responsibilities

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.
Performs other duties as assigned.
Comply with all policies and standards.