Senior Compliance Professional
Become a part of our caring community and help us put health firstThe Senior Compliance Professional serves as the designated market Compliance Officer for the Kentucky Medicaid contract. 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). 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;
- Perform risk assessments, develop and oversee action plans, and provide guidance to operational groups;
- Provide on-going oversight and monitoring of 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;
- 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;
- 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
- Coordinate and manage a standard set of data relating to regulatory standards
- Coordinate compliance related communication/interaction with outside regulators, as necessary.
Use your skills to make an impact
- Bachelor's degree
- 3 or more years of Medicaid or Regulatory Compliance experience
- Knowledge/understanding of laws and regulations governed by the Department of Insurance and CMS
- Graduate or advanced degree
- Audit or consulting experience
- Experience with metrics and reporting
Scheduled Weekly Hours40
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.