Senior Compliance Professional

Location: Remote Nationwide

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The Senior Compliance Professional 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.

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. The Senior Compliance Professional’s primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues related to Humana’s Medicaid business partner operations areas and to recommend changes that assure compliance with regulatory and contractual obligations.

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. The Senior Compliance Professional’s primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues related to Humana’s Medicaid business partner operations areas and to recommend changes that assure compliance with regulatory and contractual obligations.

Responsibilities

• 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

What makes you successful in this role

• 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