NABA Senior Compliance Professional

Humana

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Posted 6+ months ago

Description

The Senior Compliance Professional will provide guidance for the development and implementation of Humana’s Oklahoma Medicaid Compliance Program. He/she will serve as the primary point of contact for all Managed Care Organization (MCO) communications regarding compliance issues. He/she will ensure that written policies, procedures, and standards are in compliance with requirements set forth in the Contract. He/she 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.

Responsibilities

The Senior Compliance Professional will provide guidance for the development and implementation of Humana’s Oklahoma Medicaid Compliance Program. He/she will serve as the primary point of contact for all Managed Care Organization (MCO) communications regarding compliance issues. He/she will ensure that written policies, procedures, and standards are in compliance with requirements set forth in the Contract. He/she 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.

While working within assigned areas to optimize business results, you will:

Maintain 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)
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;
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.

Required Qualifications

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 skills

Preferred Qualifications

Juris Doctor or Masters of Business Administration
3 plus years of experience in Health Plan Compliance or Health Plan Operations

Additional Information

Scheduled Weekly Hours

40

This job is no longer accepting applications

See open jobs at Humana.See open jobs similar to "NABA Senior Compliance Professional" SOAR Kentucky.

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NABA Senior Compliance Professional