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Company

Centene Corporation · 1 day ago

Medicare Compliance Officer

Missouri, United States

Full-time

Remote

Director/Executive

$227K/yr - $432K/yr

10+ years exp

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Responsibilities

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

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Medicare ComplianceCompliance Program DevelopmentLeadership ExperienceLegal KnowledgeFraud Waste Abuse (FWA) ManagementRisk AssessmentCorrective Action PlansManaged Care Sector ExperienceGovernment Agency CollaborationTraining Program DevelopmentCMS Reporting ComplianceAudit Management

Required

Bachelor's Degree required

5+ years of experience in a leadership role required

10+ years of Medicare Managed Care Compliance experience required

Preferred

Juris Doctor (JD) from an accredited law school, with a strong academic record and a state bar admission

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