Centene Corporation Senior Compliance Analyst (Remote) in Boston, Massachusetts
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.
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.
• Monitor and analyze federal and state legislative and regulatory changes to identify those impacting the pharmacy and pharmacy benefit administration-related business unit.
• Review and synthesize regulatory requirements and solicit business unit input on policy and/or position statements for proposed regulations and legislation.
• Manage process of communicating state and federal requirements to internal clients and provide regulatory interpretive guidance as needed during implementation.
• Provide development guidance and assist in the identification, implementation, and maintenance of compliance policies, procedures, and work instructions related to regulatory bulletin process.
• Assist in the identification, analysis, and resolution of compliance issues.
• Maintain and review regulatory documentation necessary to maintain corporate standards.
• Serve as a business unit resource and liaison on newly adopted regulatory changes.
• Serve as project manager to maintain Regulatory Bulletin tracking tool and associated files, provide training to team members supporting Bulletin process and follow up with internal stakeholders to assure compliance.
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)
LOCATION: Various, Massachusetts
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