Compliance Professional

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Humana Healthy Horizons is seeking a Compliance Professional (Medicaid State Reporting) who will ensure compliance with governmental requirements as they relate to Medicaid State reporting. The 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.

The Compliance Professional will be responsible for coordinating and submitting required state reports for the Medicaid State Reporting team. Reporting to the Compliance Manager, you will partner with market leadership, business owners, and other stakeholders to support accurate and timely state reporting. Responsibilities may include educating business owners and market partners on state reporting processes, coordinating the collection and validation of required data, and identifying and escalating gaps in data availability that may impact reporting requirements.

• Coordinate, prepare, review, and submit required Medicaid state reports in accordance with established requirements and timelines.
• Partner with business owners, market partners, and other stakeholders to obtain information and data needed for state reporting.
• Educate and support business owners and market partners on state reporting processes, requirements, and expectations.
• Review and validate reporting data for completeness and accuracy prior to submission.
• Identify and elevate data gaps, reporting issues, or process concerns that may impact timely and accurate reporting.
• Support the implementation of new and amended state reporting requirements and guidance.
• Maintain reporting documentation and support process improvements to promote consistency, accuracy, and efficiency.

• Must reside in the eastern or central time zones within the contiguous United States
• Bachelor's degree or 5+ years of healthcare industry, insurance services and/or regulated services.
• 3 plus years compliance or project/process management experience
• Comprehensive working knowledge of all Microsoft Office applications, including Word, Excel and Power Point

• Medicaid state reporting experience
• Medicaid experience/knowledge
• Prior experience analyzing data and metrics to influence change in departmental processes
• Prior health insurance industry experience
• Experience using Microsoft Copilot

• Location:
  
  Remote US - Must reside in the eastern or central time zones within the contiguous United States

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

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.

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

40

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time…