Senior Compliance Corrections Specialist - Medicare

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: Participates in corrections process for the Medicare line of business. Responsibilities include intaking and triaging suspected issues of non-compliance, entry of compliance issues into GRC tool and assignment/coordination of issues to corrections team members; collaborating with compliance and business stakeholders to gather information, develop corrective action plans, identify and escalate barriers to progress and gather evidence of remediation; update GRC tool to support corrections reporting.

• Collaborates with compliance and business stakeholders to ensure adequate root cause analysis and development of corrective actions plans to effectively address non-compliance.
• Reviews and oversees progress towards remediation and documented key milestones in GRC tool.
• Identifies issues that require escalation and ensures they are addressed timely through established paths and processes.
• Conducts review of evidence to address root cause of issue and facilitate timely closure of issues.
• Develops, implements and continually refines corrections reporting that provides meaningful trend analysis for business stakeholders and senior leadership on new, in progress and closed issues as well as regulatory sanctions.
• Supports management in the development and maintenance of corrections processes and tools designed to effectively remediate compliance issues in a timely manner, ensure timely escalation and sustainable resolutions.
• 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.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Bachelor's Degree Healthcare of related field.
• 5+ years experience in Managed Care/Health Insurance or related experience required.
• Excellent Microsoft Office skills and experience with data analytics preferred.

Certified in HealthCare Compliance (CHC) preferred
Certified Compliance & Ethics Professional (CCEP) preferred

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act