Become a part of our caring community and help us put health first
The Senior Compliance Professional serves as the designated Regulatory Compliance contact for the Indiana Medicaid contract. 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 focus will be on preventing, detecting, and resolving 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 serves as the dedicated Compliance Officer for Virginia to 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. As a Senior Compliance Professional for our Medicaid business, you will be part of a fast-growing team who develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners and oversight agencies. While working within assigned areas to optimize business results, you will:
- Serves as dedicated Regulatory Compliance Officer for Virginia Medicaid contract.
- Build relationships with market leadership teams and external regulators;
- Provide ongoing oversight of Medicaid operations from readiness review through contract duration to ensure full compliance and minimize risk for the Enterprise;
- Perform risk assessments, develop and implement annual regulatory compliance auditing and monitoring work plans, oversee corrective action plans and document remediation activities.
- Interpret and define state and federal regulatory and contract requirements for Humana Departments and/or external business partners and provide ongoing guidance.
- Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards;
- Participate in external audits to review document submissions, prepare presenters, and coordinate responses for regulators, as necessary;
- Work across Humana operational units and product lines to enhance compliance data analytics and operational improvement efforts;
- Coordinate and manage a standard set of data relating to regulatory standards and report compliance issues to senior leadership and compliance oversight committees.
- Chair the Virginia Compliance Committee per approved charter;
- Coordinate compliance related communication/interaction with outside regulators, as necessary.
- Coordinate with the Special Investigations Unit (SIU) to operate and effective fraud, waste and abuse program integrity program.
Use your skills to make an impact
Required Qualifications
- Virginia residency required
- Bachelor’s degree in related field
- Advanced experience working in a Compliance-related or managed care-related field or Medicaid
- Knowledgeable in regulations governing health care industries
- Strong communication skills
Preferred Qualifications
- Juris Doctor and/or advanced degree
- Audit experience
- Experience with metrics and reporting
- Experience working with regulatory agencies, including state departments of health insurance and/or CMS
- Knowledgeable in process improvement
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 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 veteran status. 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.
