Compliance Analyst - Program Integrity

About the position 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, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. Position Purpose: Maintain compliance with program integrity related regulatory laws and standards, while also supporting Program Integrity in maintaining compliance with all other regulatory laws and standards, including HIPAA; program integrity reporting; and assist in developing and implementing program integrity oversight, monitoring and auditing strategies. Prepare and timely file annual and renewal program integrity filings with various state departments of insurance, state level contract holders, and federal regulators. Review and analyze state program integrity, including fraud, waste and abuse detection, investigation and prevention requirements. Review reports for program integrity related regulatory requirements, assess data collection and management processes, and recommend or develop enhancements to optimize accuracy and compliance. Review and analyze proposed contracts for program integrity reporting and other related requirements. Assist with maintaining program integrity related policies & procedures to ensure compliance with regulatory laws and standards. Maintain databases relating to federal and state program integrity requirements and program integrity oversight, including oversight activities, auditing and training. Assist with facilitation of education of employees regarding program integrity, regulatory oversight and data integrity. Assist in audits of organization for regulatory oversight of compliance and program integrity related matters. Create and maintain reports to support contractual and regulatory compliance with program integrity related regulations and requirements. Performs other duties as assigned. Complies with all policies and standards.

Responsibilities

• Maintain compliance with program integrity related regulatory laws and standards
• Prepare and timely file annual and renewal program integrity filings with various state departments of insurance, state level contract holders, and federal regulators
• Review and analyze state program integrity, including fraud, waste and abuse detection, investigation and prevention requirements
• Review reports for program integrity related regulatory requirements, assess data collection and management processes, and recommend or develop enhancements to optimize accuracy and compliance
• Review and analyze proposed contracts for program integrity reporting and other related requirements
• Assist with maintaining program integrity related policies & procedures to ensure compliance with regulatory laws and standards
• Maintain databases relating to federal and state program integrity requirements and program integrity oversight, including oversight activities, auditing and training
• Assist with facilitation of education of employees regarding program integrity, regulatory oversight and data integrity
• Assist in audits of organization for regulatory oversight of compliance and program integrity related matters
• Create and maintain reports to support contractual and regulatory compliance with program integrity related regulations and requirements
• Performs other duties as assigned
• Complies with all policies and standards

Requirements

• Bachelor’s degree in Business, Public Health, Health Care Administration, related field or equivalent experience
• 2+ years in a regulatory, compliance or legal role, preferably in healthcare or in a government agency

Nice-to-haves

• Certified Professional Coder (CPC) or other Compliance related certificates or credentials preferred

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

Apply tot his job Apply To this Job