Senior Compliance Professional - Medicaid

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Job Information
Humana
Senior Compliance Professional - Medicaid
in
San Juan
Puerto Rico
Description
The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional's work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Compliance Professional 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. The Senior Compliance Professional's primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues related to Humana's Medicaid business partner operations areas and to recommend changes that assure compliance with regulatory and contractual obligations.
Responsibilities
Responsibilities
As a Senior Compliance Professional for our Medicaid business, you will be part of a fast-growing team who develops and maintains key relationships with Humana operational leaders. While working within assigned areas to optimize business results, you will:
​Develop audit methodology and perform auditing and monitoring activities to prevent and detect issues of noncompliance and provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations;
Present findings of auditing and monitoring efforts to business partners and Enterprise Compliance leaders and track issues to ensure appropriate and timely remediation;
Oversee development and progress of issue remediation;
Review and analyze documents and data to identify what can be used to evidence meeting regulatory requirements
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 Medicaid business operations to ensure full compliance and minimize risk for the Enterprise;
Provide support in external audits;
Coordinate compliance related communication/interaction with regulators;
Provide backup and support to other Medicaid Regulatory Compliance team members and perform other duties, as needed.
Required Qualifications
Bachelor's degree in related field
Experience working in regulatory law, compliance, audit, or risk management field
Experience working in a Compliance-related or managed care-related field
Experience working with regulatory agencies
Ability to analyze regulatory requirements and assist business areas with understanding impacts of requirements on their operations
Knowledgeable in process improvement
Knowledgeable in regulations governing health care industries
Strong communication skills
Strong attention to detail
Ability to manage multiple or competing priorities and meet deadlines
Ability to perform work assignments without direction and exercise considerable latitude in determining objectives and approaches to assignments
Preferred Qualifications
Juris Doctor or Master of Business Administration or advanced degree
Audit experience
Experience with metrics and reporting
Experience in Health Plan Compliance or Health Plan Operations
Scheduled Weekly Hours
40
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ****

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