Director, Auditing, Monitoring & Oversight (Marketplace)
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, youll have access to competitive benefits including a fresh perspective on workplace flexibility.
Applicants for this role will have the flexibility to work remotely anywhere in the Continental United Sates.
Position Purpose: Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Marketplace line of business, which includes implementation of elements of an effective compliance program related to specific operational areas. Oversees the development of risk assessments and oversight and monitoring work plans pertaining to those areas. Partners with business areas to ensure implement effective prevention, detection and correction of compliance issues.
Establish a process for overseeing compliance with regulations and laws related to Marketplace requirements
Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language
Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues
Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate
Oversees team responsible for monitoring against regulatory requirements; ensures sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns
Develops and monitors metrics and other oversight tools that indicate business area compliance
Provides compliance guidance, direction and compliance risk assessment to assigned business partners
Manages and develops direct reports who include other management or supervisory personnel and/or exempt individual contributors
Plans and collaborates with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches
Sets operational priorities including the development and maintenance of effective oversight activities and prioritization of work
Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee
Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs
Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness
Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws
Makes decisions on complex issues regarding technical approach for project components and is able to work without significant direction
Performs other duties as assigned
Complies with all policies and standards
Education/Experience:
Bachelor's Degree Business Administration, Public Policy, Public Health, Health Administration or related field; or equivalent experience required: CPA, CISA, JD, MHA, MBA, MIS or equivalent experience preferred
7+ years Compliance for a managed care or health insurance company or equivalent experience required
4+ years Management experience preferred
Licenses/Certifications:
HCCA certification (CHC) or equivalent preferred
Pay Range: $116,100.00 - $214,700.00 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
Apply Now
Applicants for this role will have the flexibility to work remotely anywhere in the Continental United Sates.
Position Purpose: Provides strategic leadership and management of department overseeing compliance with regulations and laws related to Marketplace line of business, which includes implementation of elements of an effective compliance program related to specific operational areas. Oversees the development of risk assessments and oversight and monitoring work plans pertaining to those areas. Partners with business areas to ensure implement effective prevention, detection and correction of compliance issues.
Establish a process for overseeing compliance with regulations and laws related to Marketplace requirements
Provides guidance to various business departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractual language
Conducts compliance reviews and manages team that conducts compliance reviews, assisting with identification of issues and collaborating with Corrections team for remediation of issues
Performs risk assessments and report emerging trends, deficiencies and variances, report findings to other departments and teams as appropriate
Oversees team responsible for monitoring against regulatory requirements; ensures sufficient monitoring activities to assist with prevention and proactive identification of compliance concerns
Develops and monitors metrics and other oversight tools that indicate business area compliance
Provides compliance guidance, direction and compliance risk assessment to assigned business partners
Manages and develops direct reports who include other management or supervisory personnel and/or exempt individual contributors
Plans and collaborates with other teams and leaders on complex projects/programs necessitating the origination and application of new and unique approaches
Sets operational priorities including the development and maintenance of effective oversight activities and prioritization of work
Responsible for Board and Executive reporting related to responsibilities of the team and compliance of business operations for which you oversee
Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs
Participates in mock and actual CMS and other regulatory audits and coordinates with Internal Audit, Regulatory Compliance and/or Market based Regulatory Affairs on responses to agency inquiries and oversees the internal and external processes required to ensure the Company maintains a consistent state of Audit readiness
Maintains a current working knowledge of various laws, regulations, and industry guidance that impacts the health industry generally, and government programs in the health sector specifically, including fraud and abuse and anti-kickback statutes, OIG and government health plan guidelines and state marketing compliance laws, prompt pay, provider adequacy and other laws
Makes decisions on complex issues regarding technical approach for project components and is able to work without significant direction
Performs other duties as assigned
Complies with all policies and standards
Education/Experience:
Bachelor's Degree Business Administration, Public Policy, Public Health, Health Administration or related field; or equivalent experience required: CPA, CISA, JD, MHA, MBA, MIS or equivalent experience preferred
7+ years Compliance for a managed care or health insurance company or equivalent experience required
4+ years Management experience preferred
Licenses/Certifications:
HCCA certification (CHC) or equivalent preferred
Pay Range: $116,100.00 - $214,700.00 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
Apply Now