Ensure regulatory compliance with state and other government agencies related to the health insurance industry, Centene Corporation, and its business subsidiaries.
Ensure business unit and Centene Corporate are in compliance with state and federal program regulations, insurance regulations, regulatory requirements for business entities and state contract requirements
Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures. Develop policies, procedures, and processes to comply with state law, federal law, contract requirements, and various standards
Oversee, administer, and implement various compliance programs, including fraud and abuse and HIPAA
Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language
Conduct compliance audits, develop and implement corrective action plans, and report on achievement of action plans to senior management and Board of Directors
Develop strategic relationships with state legislative policymakers and assist with the development of state legislative public policy concerning state insurance, Managed Care Organization, Medicare and Medicaid regulations and initiatives
Identify, evaluate and analyze the impact of state legislative and regulatory issues and advise management concerning impact
Represent senior management at various committees, meetings, and seminars
Education/Experience: Bachelors degree in Public Policy, Government Affairs, Business Administration or related field. 8+ years of compliance program management and contract experience. Extensive knowledge of state administrative code and regulations, state insurance laws and regulations including managed care regulations. Experience with state and federal government agencies, accreditation bodies, participating provider agreements, HIPAA and Third Party Administration (TPA) laws, credentialing regulations and prompt pay laws. Master's or Law degree preferred.
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