Senior Compliance Analyst

Centene Corporation•New York, MI

3d•$70,100 - $126,200•Hybrid

About The Position

Assist in maintaining Centene Corporation’s Compliance Program. Provide regulatory interpretation, perform compliance reporting, lead special projects, and develop and implement compliance auditing and monitoring strategies. This position will have primary daily responsibility for PHW FWA activities. Assists with tracking and identifying risks and trends related to non compliance and fraud waste and abuse. Convene leaders from key operational areas (such as SIU, claims, program integrity, provider network, pharmacy, member services, and IT) to ensure that PHW has compliant end to end workflows and process for providers and members with regard to identifying, investigating and corrective actions for fraud. Ensure that PHW’s processes for the prevention, detection and recoupment of FWA activities comply with state and federal regulatory mandates and the CHC Agreement. Lead the monthly PHW fraud workgroup and the production and submission of the quarterly MCO FWA Quarterly Report. Serve as a PHW liaison to the DHS Bureau of Program Integrity and the OAG.

Requirements

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
Bachelor’s degree in related legal field or equivalent experience.
3+ years of related experience in compliance privacy and/or regulatory affairs.
Experience in project management with working knowledge of laws and/or regulations in area of compliance, in particular HIPAA, and state regulations.
Requires CFE (Certified Fraud Examiner).

Nice To Haves

Master’s or Juris Doctorate degree preferred and maybe considered in lieu of experience.

Responsibilities

Respond to external requests for information required by the organization for its regulatory filings
Manage compliance reporting responsibilities and respond to inquiries from state and federal regulatory agencies
Manage ethics and compliance projects or implementations
Review and synthesize regulatory requirements and create policy and/or position statements
Assist in managing annual code of conduct attestation and remediation
Communicate state and federal requirements to internal and external clients
Provide development guidance and assist in the identification, implementation, and maintenance of compliance policies, procedures and work instructions
Assist in the identification, analysis, and resolution of compliance issues.
Maintain and review regulatory documentation necessary to maintain corporate standards
Assist in developing, producing and conducting compliance training programs
Perform periodic compliance audits, risk assessments and conducts related to ongoing compliance monitoring activities
Assist health plans in managing relationships with regulatory agencies and seek to resolve policy issues which may negatively impact service to members
Assist management with interim health plan compliance officer responsibilities
Plan, direct and coordinate the implementation of Compliance Committee policy to ensure decisions are properly executed
Serve as a company-wide resource and liaison on policies, contract issues and provisions, communications, workflow, and quality improvements initiatives
Assists with tracking and identifying risks and trends related to non compliance and fraud waste and abuse.
Convene leaders from key operational areas (such as SIU, claims, program integrity, provider network, pharmacy, member services, and IT) to ensure that PHW has compliant end to end workflows and process for providers and members with regard to identifying, investigating and corrective actions for fraud.
Ensure that PHW’s processes for the prevention, detection and recoupment of FWA activities comply with state and federal regulatory mandates and the CHC Agreement.
Lead the monthly PHW fraud workgroup and the production and submission of the quarterly MCO FWA Quarterly Report.
Serve as a PHW liaison to the DHS Bureau of Program Integrity and the OAG.