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Centene Corporation Senior Compliance Analyst (Remote within New Mexico) in Albuquerque, New Mexico

You could be the one who changes everything for our 26 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.

This position will allow for remote work flexibility, but selected candidate will need to travel within New Mexico up to 15% of the time.

Position Purpose: 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.

• 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

Education/Experience: Bachelor’s degree in related legal field or equivalent experience. Master’s or Juris Doctorate degree preferred and maybe considered in lieu of 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.

For Pennsylvania Health & Wellness Only: 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. Requires CFE (Certified Fraud Examiner).

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.

TITLE: Senior Compliance Analyst (Remote within New Mexico)

LOCATION: Albuquerque, New Mexico

REQNUMBER: 1402100