Senior Compliance Professional - Medicaid

Profile

Description

Healthcare isn't just about health anymore. It's about caring for family, friends, finances, and personal life goals. It's about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we're seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.

Responsibilities

Assignment Capsule

Be a part of Compliance - Use your business knowledge and analytical skills to help 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. This position will be based in the Columbus, OH office. 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.


Key Competencies


Accountability: Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.
Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.
Interpersonal Effectiveness : Understands oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships. Negotiate findings and corrective actions to mitigate potential fines and sanctions.


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


Additional Information

At Humana, we are also committed to making the resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. We know your well-being is important to you, and it is important to us too. If you share our passion for helping people, we likely have the right place for you at Humana.

Scheduled Weekly Hours

40

Company info

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