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Centene Corporation · 1 day ago

Business Compliance Consultant

United States

Full-time

Remote

Senior Level

$88K/yr - $158K/yr

7+ years exp

Centene Corporation is a national organization dedicated to transforming the health of communities. The Business Compliance Consultant will work closely with various departments to ensure compliance with health care laws and manage contracts and amendments, while also participating in regulatory changes and supporting compliance training efforts.

Hospital & Health Care

Responsibilities

Conduct the review of and make changes to product-specific contracts and amendments between Health Plan and Material Subcontractors

Remain up to date on all state and federal health care laws, including laws applicable to managed care industry, and on all IN Medicaid contracts and amendments

Perform legal research and prepare memoranda regarding legislative or regulatory changes affecting the company’s vendor and/or health care provider contracts

Coordinate SIU waste and abuse efforts with the Corporate SIU Team

Complete all research on and file preparation for State Fair Hearings between Health Plan and State Regulatory Agency. Represent MHS at all State Fair Hearings. Track all outcomes and provide reports to Senior Leadership on outcomes. Collaborate with cross-functionally to remedy MHS process issues

Identifies issues with questionable billing providers and vendor contracts. Tracks trends for department use and Corporate Compliance. Escalates as required to senior management

Coordinates department preparation for State Fair Hearings and Questionable Provider Audits (building case files, universes, evidence of compliance and other documentation as needed)

Completes all required compliance training

Participate in implementation of regulatory changes that span multiple departments, as needed

Provide support and input into the development and maintenance of a consistent process for identification and escalation of issues and supporting tools; may participate in the implementation of a tool(s) for maintenance of mapping requirements/regulations to policies and procedures (P&Ps) and owners (i.e. CFR owners)

Participate in developing and maintaining consistent processes/methods for development, implementation, communication and training on new/updated policies and procedures

Participate with Business Units/departments with an end-to-end process orientation to ensure appropriate connectivity and handoffs are built into P&Ps that span multiple departments

Participates in and supports other programs such as privacy and security (including HIPAA program), Ethics & Privacy, Fraud Waste & Abuse, Code of Conduct, etc

Performs other duties as assigned