Compliance & Reporting Specialist - #193160

Carolina Complete Health

Date: 5 days ago
City: Winston-Salem, NC
Contract type: Full time
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.

This role is remote to North Carolina only

Position Purpose: With the Carolina Complete Health Compliance team, you will develop, implement, and perform compliance auditing, monitoring and reporting activities based on established program, policies, and practices to ensure and maintain compliance with federal, state, and local regulatory and contractual requirements.

  • Develop and maintain quality and compliance reports and dashboards
  • Analyze error reports received from the Medicaid agency and work with business owners to correct them before resubmission.
  • Perform and monitor audits, risk assessments and documentation activities to ensure compliance
  • Identify, investigate, and resolve compliance issues and develop corrective action plans to mitigate future risks
  • Serve as the “go to” person for all compliance activities including training and awareness programs
  • Design, implement and improve regulatory documentation and processes to address compliance issues and concerns related to all federal and state regulatory requirements, contract requirements and company standards
  • Research new markets and primary source verification to determine licensure requirements and administer ongoing licensure maintenance
  • Assist with vendor activities, including documentation of all pre- and annual delegate oversight and on-going vendor oversight and partnership activities
  • Update management on the status and activities pertaining to compliance, contract deliverables and related activities

Required Education/Experience: Bachelor’s degree in health care administration, compliance, or related field or equivalent experience. 2-4 years of compliance, regulatory, or related experience. Experience with risk assessment requirements, auditing and reporting processes, action plans, and compliance training.

Preferred Skills

Strong writing skills

Strong communication skills, be detail oriented, and have an interest in analyzing reports to identify errors.

Pay Range: $54,000.00 - $97,100.00 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.

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