Position Purpose: Ensure regulatory compliance with state and other government agencies related to the health insurance industry, Centene Corporation, and its business subsidiaries.
- Develop and implement strategic vision for compliance and ethics culture within the business unit ensuring alignment with Corporate
- Ensure business unit are in compliance with state and federal program regulations, insurance regulations, regulatory requirements for business entities and state contract requirements
- Develop policies, procedures, and processes to ensure compliance with state law, federal law, contract requirements, and various standards
- Oversee compliance integration and support of business operations and support units
- Oversee, administer, and implement various compliance programs, including fraud and abuse and HIPAA
- Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements related to regulatory and contractlanguage
- Develop strategic relationships with state and federal regulators and assist with the development of internal and external policies concerning state insurance, Managed Care Organization, Medicare and Medicaid regulations and initiatives
- Identify, evaluate and analyze the impact of state and federal, regulation, policy and contract requirements; resulting issues, develop positions, alternatives, recommendations advise management concerning impact
- Oversee fraud and abuse programs on the health plan level, collaborating with the special investigation unit team and serving as main regulatory liaison
- Oversee development or adoption of Corporate’s special investigation, ethics and compliance training to include delivery, monitoring and reporting
- Conduct compliance monitoring, develop and implement performance improvement plans, corrective action plans, and report on achievement of action plans to senior management
- Oversee the maintenance and tracking of laws and regulations, contract documentations, amendments, and various compliance measures and ensure appropriates are taken to address changes
Education/Experience: Bachelor's degree in Public Policy, Government Affairs, Business Administration or related field.
10+ years of compliance program management and contract experience.
Extensive knowledge of state administrative code and regulations, state insurance laws and regulations including managed care regulations.
Experience with state and federal government agencies, accreditation bodies, participating provider agreements, HIPAA and Third Party Administration (TPA) laws, credentialing regulations and prompt pay laws.
Master’s or Law degree preferred.
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.