Humana Application – Sr Compliance Professional

Job Description:

The Senior Compliance Professional will 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).

Job Responsibilities:

• Provide on-going oversight and monitoring of Medicaid business operations to ensure full compliance and minimize risk for the Enterprise;
• Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners;
• Build relationships with responsible market contacts and external regulators;
• Serve as a translator between Humana business leaders and State and Federal Medicaid/Medicare
• Departments assisting with the interpretation of the intention of the guidelines;
• Coordinate and manage a standard set of data relating to regulatory standards
• Coordinate compliance related communication/interaction with outside regulators, as necessary.
• Perform risk assessments, develop and oversee action plans, and provide guidance to operational groups;
• Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards;
• Act as a key participant in both on and offsite external audits, including state contract audits and CMS program audits, working with the regulators, as necessary;
• Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts

Job Requirements:

• Knowledgeable in regulations governing health care industries
• Knowledgeable in process improvement and metrics development
• Strong communication skills

Qualification & Experience:

• Audit or consulting experience
• Experience with metrics and reporting
• Bachelor’s degree in related field
• Experience in Health Plan Compliance or Health Plan Operations
• Juris Doctor or Masters of Business Administration or advanced degree
• 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

Job Details:

Company: Humana

Vacancy Type: Full Time

Job Location: Metairie, LA, US

Application Deadline: N/A

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