DescriptionThe Senior Compliance Professional 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.ResponsibilitiesHumana is seeking a Senior Compliance Professional to analyze and develop policies, procedures and programs supporting our compliance initiatives. Humana is seeking a Senior Compliance Professional 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, the State Medicaid Office and/or the Centers for Medicare and Medicaid Services (CMS). While working within assigned areas to optimize business results, you will:* 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 all Medicaid business operations to ensure full compliance and minimize risk for the Enterprise;* Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards;* Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts* Coordinate and manage a standard set of data relating to regulatory standards* Perform risk assessments, develop and oversee action plans, and provide guidance to operational groups;* Build relationships with responsible market contacts and external regulators;* Serve as a translator between Humana business leaders and State and Federal Medicaid Departments assisting with the interpretation of the intention of the guidelines;* Coordinate day-to-day interaction with outside regulators as necessary;* Act as a key participant in both on and offsite external audits, working with the regulators, as necessary.Role Essentials* Bachelor's degree in related field* Advanced experience working in a Compliance-related or managed care-related field* Experience working with regulatory agencies, including state departments of health insurance and/or CMS* Knowledgeable in process improvement and metrics development* Knowledgeable in regulations governing health care industries* Strong communication skillsRole Desirables* Juris Doctor or Masters of Business Administration* 3 plus years of experience in Health Plan Compliance or Health Plan OperationsScheduled Weekly Hours40 Associated topics: company, compliance department, corporate, corporate attorney, counsel, court, internal, legal, legal department, llp
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.