Senior Compliance Professional, Medicaid

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The Senior Compliance Professional for Medicaid ensures compliance with governmental requirements. The Senior Compliance Professional's work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

As a Senior Compliance Professional for our Medicaid business, you will be part of a fast-growing team who develops and maintains key relationships with Humana operational leaders. While working within assigned areas to optimize business results, you will:

• Develop audit methodology and perform auditing and monitoring activities 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;
• Present findings of auditing and monitoring efforts to business partners and Enterprise Compliance leaders and track issues to ensure appropriate and timely remediation;
• Oversee development and progress of issue remediation;
• Review and analyze documents and data to identify what can be used to evidence meeting regulatory requirements
• 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 Medicaid business operations to ensure full compliance and minimize risk for the Enterprise;
• Provide support in external audits;
• Coordinate compliance related communication/interaction with regulators;
• Provide backup and support to other Medicaid Regulatory Compliance team members and perform other duties, as needed.

• Being knowledgeable in process improvement
• Demonstrated knowledge in regulations governing health care industries
• Strong written and verbal communication skills
• Strong attention to detail
• Being able to manage multiple or competing priorities and meet deadlines
• Performing work assignments without direction and exercising considerable latitude in determining objectives and approaches to assignments

• 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

• Juris Doctor or Master of Business Administration or advanced degree
• Audit experience
• Experience with metrics and reporting
• Experience in Health Plan Compliance or Health Plan Operations

Additional information:

This role is an individual contributor.

This role will have limited travel based on business needs.

This role is fully remote within the U.S.

Work at Home Requirements:
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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