1+ months

Senior Compliance Professional

Humana
Columbia, SC 29240
**Description** The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. **Responsibilities** Humana is seeking a Senior Compliance Professional to analyze and develop policies, procedures and programs supporting our compliance initiatives. Humana is seeking a Senior Compliance Professional to analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. As a Senior Compliance Professional for our Medicaid business, you will be part of a fast-growing team who develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners, the State Medicaid Office and/or the Centers for Medicare and Medicaid Services (CMS). While working within assigned areas to optimize business results, you will: + Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners; + Provide on-going oversight and monitoring of all Medicaid business operations to ensure full compliance and minimize risk for the Enterprise; + Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards; + Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts + Coordinate and manage a standard set of data relating to regulatory standards + Perform risk assessments, develop and oversee action plans, and provide guidance to operational groups; + Build relationships with responsible market contacts and external regulators; + Serve as a translator between Humana business leaders and State and Federal Medicaid Departments assisting with the interpretation of the intention of the guidelines; + Coordinate day-to-day interaction with outside regulators as necessary; + Act as a key participant in both on and offsite external audits, working with the regulators, as necessary. **Role Essentials** + Bachelor's degree in related field + Advanced experience working in a Compliance-related or managed care-related field + Experience working with regulatory agencies, including state departments of health insurance and/or CMS + Knowledgeable in process improvement and metrics development + Knowledgeable in regulations governing health care industries + Strong communication skills **Role Desirables** + Juris Doctor or Masters of Business Administration + 3 plus years of experience in Health Plan Compliance or Health Plan Operations + Experience with Long Term Care Support Services and/or Medicare-Medicaid Dual populations/programs preferred **Scheduled Weekly Hours** 40 <>

Categories

Posted: 2020-11-23 Expires: 2021-03-24

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

Senior Compliance Professional

Humana
Columbia, SC 29240

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast