Business Compliance Consultant
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $87,700 - $157,800 per year
About the role
- 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.
Requirements
- BA degree in Business Administration, Finance or related field
- Five to ten years experience in progressively broad and challenging roles in a given operational area
- Prior experience in a compliance-related role highly desirable
- For MHS Indiana plan only: 7+ years of combined contract drafting and legal research experience
- Knowledge of the health care industry, specifically government services and applicable laws and regulations
- Advanced knowledge of Indiana Medicaid insurance, Indiana Administrative Code and Code of Federal Regulations preferred.
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
contract draftinglegal researchcompliance trainingreportingdata analysiscase file preparationissue identificationprocess developmentpolicy implementationregulatory change management
Soft skills
collaborationcommunicationproblem-solvingorganizational skillsleadershipattention to detailcritical thinkingescalation managementcross-functional teamworkadaptability