13 days old

Senior Compliance Professional

Humana
Louisville, KY 40290
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 The Senior Compliance Professional develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with regulatory and contract obligations. Coordinates business partner engagement in site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Provides compliance guidance, direction and compliance risk assessment to assigned business partners, Conducts periodic compliance reviews of business partner operations. Monitors metrics and other oversight tools that indicate business area compliance. Recommends new measures of compliance performance. Works with systems to track issues and corrective actions, when needed. Begins to influence departments strategy. Makes decisions on moderately complex-to-complex issues regarding technical approach for project components, and work is performed with minimal direction. Exercises considerable latitude in determining objectives and approaches to assignments. The Senior Compliance Professionals primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues to help ensure an effective compliance program for Customer Service/Call Center operations. + Research, understand and apply laws, regulations, and regulatory guidance related to the Customer Service/Call Center for Medicare lines of business. + Serve as the subject matter expert on Customer Service/Call Center issues for the Medicare line of business as it relates to compliance. + Develop audit methodology and perform auditing and monitoring activity to prevent and detect issues of noncompliance and provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations. + Analyze business requirements and complex issues, conduct research, and provide regulatory guidance to business partners, Law, and Enterprise Compliance associates and leaders with regard to Customer Service/Call Center compliance issues. + Develop and track compliance metrics to help monitor and detect potential compliance issues. + Partner with Enterprise Compliance team members on regulatory outreach. + Serve as the Regulatory Compliance subject matter expert during CMS program audits. + Collaborate during onsite program audit preparation and activity and perform oversight of business audit preparation to ensure timely, accurate and complete submission of required data and documentation to regulators. + Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders and track issue to ensure appropriate and timely remediation. + Lead and participate on committees, providing compliance guidance and direction. + Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed. Required Qualifications + Bachelor's degree + Advanced experience working in compliance, risk management, or managed-care field + Knowledge/understanding of laws and regulations governed by CMS + Strong communication skills with the ability to influence effectively + Comprehensive knowledge of (MS Word, Power Point, Excel) + Excellent communication skills, both oral and written Preferred Qualifications + Audit or consulting experience + Experience with metrics and reporting + Experience in Compliance, Risk Management or related area + MBA, Juris Doctor, or other graduate degree Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request. <>

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Posted: 2019-08-05 Expires: 2019-09-13

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Senior Compliance Professional

Humana
Louisville, KY 40290

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