Medicare Compliance Officer at Centene

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.

Position Purpose: This position will be a member of Medicare & Compliance Senior Leadership, chairs Centene's Medicare Compliance Committee, attends meetings of the Enterprise Compliance Committee (ECC), and does not have financial, operational, or other non-compliance duties. This position is expected to promote an appropriate "Tone at the Top" of the organization with a commitment to service leadership.

• Leading the Medicare Compliance team with a collaborative mindset and demonstrated commitment to excellence
• Developing a best-in-class Medicare Compliance Program that exceeds stakeholder expectations
• Ensuring that Medicare Compliance reports are provided regularly to the CRECO, the Medicare Compliance Committee, the Medicare Senior Leadership team and the A&CC of the Board
• Through appropriate designees, ensuring that colleagues receive timely and practical advice regarding new guidance from federal and state regulators ensuring that all Medicare Compliance policies and procedures are reviewed annually and revised, as necessary, to reflect relevant legal, regulatory, and administrative developments and to address any compliance concerns or gaps that have been identified
• Creating and coordinating, by appropriate delegation as warranted, education training program to ensure that the Board, officers, employees, First Tier Downstream and Related Entities (FDRs), and other individuals and entities are knowledgeable about the Enterprise Ethics and Compliance Program, Centene’s Business Ethics and Code of Conduct (Code), the Company’s compliance policies and procedures and applicable statutory, regulatory, and administrative requirements
• Facilitating a quarterly Medicare Compliance Risk Assessment and developing an annual Compliance work plan
• Chairing the quarterly Medicare Compliance Committee and ensuring appropriate reporting is provided to the Committee
• Developing and implementing methods and programs that encourage managers and employees to report, without fear of retaliation, good faith concerns regarding Medicare non-compliance and potential instances of fraud, waste and abuse (FWA)
• Responding to reports of potential FWA, including the coordination of internal investigations with the Special Investigations Unit and the development of appropriate corrective or disciplinary actions
• Ensuring, by appropriate delegation as warranted, that all applicable government exclusion lists, including, but not limited to those issued by the Office of Inspector General, U.S. Department of Health and Human Services and the Government Services Administration are screened monthly with respect to all Board members, employees and FDRs and that any identified personnel issues are promptly addressed in accordance with applicable policies and procedures
• Maintaining documentation for each report of potential non-compliance or potential FWA received from any source, through any reporting channel or mechanism
• Overseeing the development and implementation of Corrective Action Plans
• Coordinating potential fraud investigations and referrals from and with the SIU, where applicable, and the appropriate National Benefit Integrity Medicare Drug Integrity Contractor
• As appropriate and in coordination with the SIU, collaborating with other sponsors, State Medicaid programs, Medicaid Fraud Control Units, commercial payers, and other organizations when a potential FWA issue is discovered that involves multiple parties
• Ensuring that data and other information and materials submitted to CMS are accurate and in compliance with CMS reporting requirements
• Reporting potential FWA to CMS, its designees and other regulatory and enforcement agencies
• Directing, through one or more designees, audits and investigations of FDRs
• Directing, through one or designees, audits of any area or function involved with Medicare Parts C or D plans
• Interviewing, personally or through designees, employees and other relevant individuals regarding Medicare compliance issues
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:
Bachelor's Degree required: Juris Doctor (JD) from an accredited law school, with a strong academic record and a state bar admission preferred
5+ years of experience in a leadership role required
10+ years of Medicare Managed Care Compliance experience required
Experience in the managed care sector preferred, ideally with rigorous professional training in a law firm, corporate legal or compliance department and/or relevant government agency preferredPay Range: $227,400.00 - $431,900.00 per year

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