Senior Compliance amp Regulatory Professional

Profile

Description

The 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.

Responsibilities

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.

Manage, Organize and Monitor the internal Humana Ohio Medicaid mailbox

Create reports, spreadsheets and Power Point presentations

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

Required Qualifications

Bachelor's degree

3-5 or more years of managed care

5 or more years of technical experience

Knowledge/understanding of laws and regulations governed by the Department of Insurance and CMS

Preferred Qualifications

advanced or graduate degree

Audit or consulting experience

Experience with metrics and reporting

Additional Information

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com