Senior Compliance Analyst
About The Position
Assist in maintaining Centene Corporation’s Compliance Program. The role provides regulatory interpretation, performs compliance reporting, leads special projects, and develops and implements compliance auditing and monitoring strategies. It responds to external requests for information needed for regulatory filings; manages reporting responsibilities and inquiries from state and federal regulatory agencies; and manages ethics and compliance projects or implementations. The position reviews and synthesizes regulatory requirements into policies or position statements, supports annual code of conduct attestation and remediation, communicates requirements to internal and external clients, and helps develop and maintain compliance policies, procedures, and work instructions. It also assists with identifying, analyzing, and resolving compliance issues; maintains and reviews regulatory documentation; supports compliance training; and performs periodic audits, risk assessments, and monitoring activities. The role supports health plans’ relationships with regulatory agencies and resolution of policy issues that could negatively affect member services. It may assist management with interim health plan compliance officer responsibilities, coordinate implementation of Compliance Committee policy, and serve as a company-wide resource on policies, contract issues and provisions, communications, workflow, and quality improvement initiatives. For Pennsylvania Health & Wellness, the position has primary daily responsibility for PHW fraud, waste, and abuse (FWA) activities. This includes tracking and identifying risks and trends, coordinating leaders across operational areas to maintain compliant workflows for providers and members, ensuring FWA prevention, detection, and recoupment processes meet applicable mandates and the CHC Agreement, leading the monthly PHW fraud workgroup, producing and submitting the quarterly MCO FWA Quarterly Report, and serving as a liaison to the DHS Bureau of Program Integrity and the OAG. A Certified Fraud Examiner (CFE) is required for this PHW-specific scope. Applicants must be authorized to work in the United States without current or future employment-based visa sponsorship. The position offers a pay range of $70,100 to $126,200 per year. Centene describes a flexible approach to work that may include remote, hybrid, field, or office schedules; the specific arrangement for this position is not stated.
Requirements
- Bachelor’s degree in a related legal field or equivalent experience.
- At least 3 years of related experience in compliance, privacy, and/or regulatory affairs.
- Project management experience.
- Working knowledge of laws and regulations in the area of compliance, particularly HIPAA and state regulations.
- Must be authorized to work in the United States without the need for current or future employment-based visa sponsorship.
- For the Pennsylvania Health & Wellness-specific responsibilities, Certified Fraud Examiner (CFE) certification is required.
Nice To Haves
- Master’s degree or Juris Doctorate degree is preferred and may be considered in lieu of experience.
Responsibilities
- Respond to external requests for information required for 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 policies 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 with identifying, implementing, and maintaining compliance policies, procedures, and work instructions.
- Assist in identifying, analyzing, and resolving 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 and risk assessments and conduct ongoing compliance monitoring activities.
- Assist health plans in managing relationships with regulatory agencies and resolving policy issues that may negatively affect member services.
- Assist management with interim health plan compliance officer responsibilities.
- Plan, direct, and coordinate 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 improvement initiatives.
- For Pennsylvania Health & Wellness, track and identify risks and trends related to noncompliance and FWA.
- For Pennsylvania Health & Wellness, convene leaders from key operational areas to ensure compliant end-to-end workflows and processes for providers and members concerning fraud identification, investigation, and corrective actions.
- For Pennsylvania Health & Wellness, ensure FWA prevention, detection, and recoupment processes comply with state and federal mandates and the CHC Agreement.
- For Pennsylvania Health & Wellness, lead the monthly PHW fraud workgroup and produce and submit the quarterly MCO FWA Quarterly Report.
- For Pennsylvania Health & Wellness, serve as a liaison to the DHS Bureau of Program Integrity and the OAG.
Benefits
- Competitive pay
- Health insurance
- 401(k)
- Stock purchase plans
- Tuition reimbursement
- Paid time off
- Paid holidays
- Flexible approach to work schedules, potentially including remote, hybrid, field, or office work
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What This Job Offers
Job Type
Full-time
Career Level
Senior
