Senior Compliance Professional, Medicaid
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Job Description
Senior Compliance Professional ensuring Medicaid regulatory compliance for Humana’s healthcare and insurance services. Developing audits, monitoring operations, and coordinating remediation with business leaders and regulators.
Responsibilities:
- Develop audit methodology and perform auditing and monitoring activities to prevent and detect noncompliance
- Provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations
- Present audit and monitoring findings to business partners and Enterprise Compliance leaders
- Track issues to ensure appropriate and timely remediation
- Oversee development and progress of issue remediation
- Review and analyze documents and data to evidence compliance with regulatory requirements
- Interpret and define regulatory and contract requirements for implementation by Humana departments and external business partners
- Provide ongoing oversight and monitoring of Medicaid business operations
- Support external audits
- Coordinate compliance-related communication and interaction with regulators
- Provide backup and support to other Medicaid Regulatory Compliance team members
- Perform other duties as needed
- Serve as an individual contributor
Requirements:
- Bachelor’s degree in related field
- 5+ years of experience working in regulatory law, compliance, audit, or risk management field
- Experience working in a Compliance-related or managed care-related field
- Experience working with regulatory agencies
- Ability to analyze regulatory requirements and assist business areas with understanding impacts of requirements on their operations
- Knowledge of process improvement
- Knowledge of regulations governing health care industries
- Strong written and verbal communication skills
- Strong attention to detail
- Ability to manage multiple or competing priorities and meet deadlines
- Ability to perform work assignments without direction and exercise considerable latitude in determining objectives and approaches
- Fully remote within the U.S.
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
- Home internet with at least 25 Mbps download and 10 Mbps upload speeds
Benefits:
- Bonus incentive plan based on company and/or individual performance
- Medical benefits
- Dental benefits
- Vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company holidays
- Personal holidays
- Paid parental leave
- Paid caregiver leave
- Short-term disability
- Long-term disability
- Life insurance
- Limited travel based on business needs
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