Senior Compliance Professional - Work at Home

Profile

Description

The Senior Compliance Professional will work with Humana Primary Care Organization's internal business partners to oversee and track compliance issues, trend data, prepare regular reporting, provide compliance support to PCO business owners, and manage oversight of project deadlines for new plan year initiatives. The Senior Compliance Professional will assist the Compliance Manager/Assistant Director in managing the Compliance Program and providing support for regulatory audits. The Senior Compliance Professional will be responsible for drafting internal and external communications regarding compliance issues and remediation, advising PCO business owners on issues with compliance implications, and represents the Compliance and Risk Management Department in multi-departmental initiatives.

This position will report directly to the Assistant Director.

Responsibilities

About Us

The Primary Care Organization (PCO), is looking for high potential candidates who are looking to accelerate their career development and contribute to driving disruption in the health care industry. The PCO provides primary care medical group practice with centers open or opening in Florida, Georgia, Kansas, Louisiana, Missouri, Nevada, North Carolina, South Carolina and Texas. The PCO has a strong emphasis on senior-focused primary care for members of Medicare Advantage health plans and is committed to providing personalized, high-quality primary care combined with an excellent patient experience.

At PCO we want to help those in the communities we serve, including our associates, lead their best lives. We support our associates in becoming happier, healthier, and more productive in their professional and personal lives. We promote lifelong well-being by giving our associate fresh perspective, new insights, and exciting opportunities to grow their careers. Our culture is focused on teamwork and providing a positive and welcoming environment for all.

We have over 215 clinics nationwide and counting - come join us

The Role

The Senior Compliance Professional develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with governmental obligations. Maintains relationships with government agencies. Senior Compliance Professional will:


Manages compliance program oversight of the business by driving auditing and monitoring activities, providing compliance guidance to the business, and tracking relevant laws and regulations and staying current on changes impacting healthcare compliance.
Prepares compliance reports, guidance memoranda, and data analytics for internal senior management, or regulatory agencies as required.
Ensures that project/department milestones/goals are met.
Contributes to annual and longer-range development and implementation of company's compliance risk assessment plans and compliance work plans.
Proactively identifies and addresses compliance issues, and effectively integrates compliance risks/issues and business knowledge to address compliance issues and/or identified risks.
Leads and/or participates, with limited direction, in cross-functional internal committees, and can represent the Compliance and Risk Management Department on cross-functional review/decision-making committees of significant impact across the organization.
Develop and provide compliance training;
Assist compliance management and senior leaders with federal, state, and/or administrative disclosure requirements;
Reviews data to determine instances of suspected fraud, waste, and abuse;
Where applicable, manages outside vendors to ensure on-time, on-target, and within-budget deliverables; and
Assists with other Compliance and Risk Management Department duties and/or projects as assigned.


Vaccine Policy

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters.

Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field.

Required Qualifications


Bachelor's Degree in a related discipline (including but not limited to health sciences, pre-law, public policy, healthcare administration, risk management, accounting, or auditing)
A minimum of four years of work experience in healthcare compliance, corporate compliance, healthcare policy, legal, or relevant field
Knowledge/understanding of laws and regulations as it relates to healthcare compliance in Medicare, Medicaid, and/or clinical industries (includes anti-kickback and Stark statutes, government fraud, waste, and abuse, false claims, HIPAA/ Privacy, grievances, patient electronic record surveillance, release of information, etc.)
Excellent verbal, interpersonal, and written communication skills
Proven ability to synthesize and summarize complex and/or voluminous content into clear, concise and actionable communications
Experience effectively identifying, developing, and implementing process improvements; to include 'outside of the box' solutions
Excellent in building and cultivating relationships with key business partners and stakeholders across organizational levels
Excellent project management skills: can prioritize multiple tasks and goals to ensure timely, on-target and within-budget accomplishment of such
Demonstrates intermediate computer skills including Microsoft Office suite of software applications in Excel and PowerPoint


Preferred Qualifications


Graduate or advanced degree
Previous experience in a healthcare provider organization and/or Medicare & Medicaid, Medicare Advantage, or government oversight strongly preferred
Healthcare Compliance Certification or other relevant professional certification *Please note if you are currently not certified, we will require completion of Humana approved certification program within one year from hire date*


Additional Information


Ability to travel to the various clinic locations; <25%
This is a remote position; we are targeting candidates who reside in: KY,FL, LA, NV, TN, TX, LA, or GA. These are preferred locations.
Work Days/Hours: Monday - Friday; Eastern Standard Time


#LI-Remote

Scheduled Weekly Hours

40

Company info

Sign Up Now - ComplianceCrossing.com