Senior Compliance Administrator - Network, Provider, Product

Centene Corporation•New York, CT

14d•$87,700 - $157,800

About The Position

The Senior Compliance Administrator is an individual contributor and subject matter expert who supports the day-to-day execution of the Medicare Compliance Advisory program in alignment with CMS requirements and applicable federal and state regulations. The role provides regulatory guidance, research and analysis, issue tracking, audit-readiness support, and assistance with compliance workplan activities. It partners closely with the Sr. Manager, Medicare Compliance Advisory to interpret CMS requirements accurately, complete assignments on time, and consistently document compliance risks, trends, and corrective actions. The position also advises business stakeholders, supports regulatory communications and filings, assesses risks and business processes, contributes to audits and monitoring, and helps develop and validate corrective actions. It collaborates with compliance, legal, audit, operational, and other internal and external partners to coordinate compliance activities and improve program processes.

Requirements

Bachelor’s degree in a related field, such as healthcare administration, public health, or policy, or equivalent experience.
At least 5 years of experience in compliance, regulatory, operations, or risk management within a regulated industry.
At least 4 years of compliance advisory experience, including regulatory research and drafting compliance guidance, risk assessment, issue tracking, auditing or monitoring, and oversight of corrective action plan development and implementation.
At least 2 years of experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.
Foundational knowledge of Medicare regulations, including CMS guidance and compliance expectations for Parts C and D.
Strong written and verbal communication skills.
Strong analytical, organizational, and documentation skills with attention to detail.
Ability to manage multiple assignments and meet deadlines in a fast-paced environment.

Nice To Haves

Master’s degree or Juris Doctor.
Certified in Healthcare Compliance (CHC).
Familiarity with CMS audit protocols, program audits, or monitoring activities.
Experience working in a matrixed or cross-functional environment.

Responsibilities

Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, supporting the prevention, detection, and correction of noncompliance and fraud, waste, and abuse (FWA).
Interpret and translate federal, state, and contractual requirements into actionable compliance guidance for business stakeholders.
Develop and coordinate regulatory communications, including responses to inquiries, issue summaries, and disclosures, and liaise with internal stakeholders and external regulators as appropriate.
Support the preparation, validation, and submission of regulatory reports, attestations, and filings, ensuring accuracy, completeness, and timeliness.
Identify compliance risks, assess business processes and exposure, stratify risk, and recommend mitigation strategies.
Lead or support issue identification, root cause analysis, and development of corrective action plans.
Provide subject matter expertise for audit and monitoring activities, including audit scope development, testing strategies, and ongoing compliance oversight.
Partner with internal and external stakeholders on audit execution, regulatory reviews, and audit readiness.
Evaluate remediation plans and validate corrective actions for sustainable, compliant resolution, including assessing regulatory reporting or disclosure requirements.
Contribute to compliance training and mentor stakeholders on regulatory requirements, policies, and best practices.
Review policies, procedures, and business processes for alignment with regulatory and contractual requirements and organizational standards.
Lead or contribute to cross-functional initiatives to improve compliance processes, operational efficiency, and alignment with organizational objectives.
Monitor regulatory developments and industry trends to identify emerging risks and support continuous improvement.
Collaborate with compliance, legal, audit, and operational partners to coordinate compliance activities across business areas.
Perform other duties as assigned.
Comply with all policies and standards.