Senior Compliance and Quality Professional

Profile

Description

The Senior Compliance and Quality Professional contributes to the success of Humana's business strategy by supporting quality and compliance initiatives across Service Operations teams within the Author organization. You understand business process flows, Medicare regulations, and operating standards. The Senior Compliance and Quality Professional develops and implements controls and cost-effective approaches to minimize the organization's risks; assesses and communicates information regarding business risks with functions across the organization and begins to influence department's strategy; makes decisions on moderately complex to complex issues, and work is performed without direction.

Responsibilities

The Senior Quality Compliance Professional


Develops, plans, and executes audit scope and inspection testing to provide assurance around the effectiveness and efficiency of operational processes
Performs targeted reviews of processes, documentation, metrics, and data sets to identify strategic, operational, and compliance risks/gaps
Oversees the identification, analysis, mitigation, tracking and reporting of strategic, operational, and compliance risks in collaboration with the business
Develops and assists with implementation of remediation activities
Leads discussions and working sessions with leaders within Service Operations and across the company
Creates and presents deliverables that clearly describe the project objectives and scope, issues, and articulates findings and recommendations
Serves as a problem solver, provides recommendations, and implements change
Works collaboratively with other oversight groups including Author Compliance, Legal, Enterprise Compliance and Quality, Regulatory Compliance, and Internal Audit


Required Qualifications


Bachelor's degree or equivalent work experience
Extensive Medicare knowledge required
5 or more years of audit, compliance, risk and/or process consulting experience
Successful track record in facilitating and consulting across teams and managing projects
Likes to focus on the big picture and thrives in a fast paced, multi-project work environment
Comprehensive knowledge of (MS Word, Power Point, Excel)
Excellent communication skills, both oral and written


Preferred Qualifications


Advanced certifications such as Six Sigma Green Belt, PMP, Lean
Medicare claims processing background
Prior audit experience preferred
Previous experience in home health, care delivery, or care management


Additional Information

Humana is an organization with careers that change lives-including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you are ready to help people achieve lifelong well-being and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

#Author

Scheduled Weekly Hours

40

Company info

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