Senior Compliance Professional

Become a part of our caring community and help us put health first
 

Humana Healthy Horizons in Ohio is seeking a Senior Compliance Professional who ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

You will be part of a caring community at Humana. When you meet us, you can tell we started as a hometown company. We’re proud of our Louisville roots and, as we’ve grown, that community feeling has spread across all 50 states and Puerto Rico. No matter where you are—whether you’re working from home, from the field, from our offices, or from somewhere in between—you’ll feel welcome here. We’re a caring community made of close-knit teams, cross-country friendships, and inclusive resource groups, all gathered around one big table where everyone’s voice is heard and respected. Community is a verb here. It’s up to each of us to care for it and maintain it. Because the relationships we form will help us deliver better health outcomes for the people we so proudly serve.

Are you Caring, Curious and Committed? If so, apply today!

The Senior Compliance Professional develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Key Responsibilities

• Manage, Organize and Monitor the internal Humana Ohio Medicaid mailbox

• Create reports, spreadsheets and Power Point presentations

• Lead various Project Management Projects

• Execute intake and tracking process and ensure changes are centrally documented in the Regulatory Repository

• Coordinate and compose time sensitive responses to incoming regulatory inquiries and issues reflective of compliance with program requirements

• Collaborate with internal business owners to ensure accurate and timely delivery of documents, including reports, prior to submission to regulatory agencies

• Develop and maintain schedules of state and Federal deadlines and deliverables and ensure timely submission of accurate deliverables

• Provide interpretation and guidance to the organization in regard to regulatory requirements and government contract administration

• Lead the communication of annual and interim contract amendments in conjunction with appropriate business owners

• Interact with regulators within the scope of responsibilities

• Participate in Regulatory audits and site visits

• Works collaboratively to develop and deliver compliance training programs, ensuring organizational workforce are knowledgeable of applicable laws

• Establish and maintain collaborative working relationship with assigned regulatory agency and other key industry stakeholders.

• Develop and maintain relationships with key internal and external stakeholders to ensure successful collaboration

• Identify and recommend performance improvement opportunities

• Report potential risks, non-compliance or alleged violations to Leadership

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree

• 3+ years of managed care experience

• Knowledge/understanding of laws and regulations governed by the Ohio Department of Medicaid

Preferred Qualifications

• Advanced or graduate degree

• Project Management experience or PMP certification

• Audit or consulting experience

• Experience with metrics and reporting

Additional Information

About Humana

Your growth is what drives Humana forward. 

• When you get here, the journey is just beginning. Our leaders are committed to understanding what you need to grow. Because we don’t grow without you
• This is a place where our nurses influence the C-suite.
• Where software engineers change lives.
• Where every associate can build a professional path where they learn and thrive.
• Through our commitments to wellbeing and work-life balance, we support each associate’s personal health, purpose, work style, sense of belonging, and security.
• Because finding new ways to put health first—for our members and patients and  our associates alike—is what we do. 

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 recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$84,600 - $116,300 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.