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Virginia Residency required

The Senior Compliance Professional serves as the designated Compliance Officer for the Virginia Medicaid contract. 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 focus will be on preventing, detecting, and resolving compliance issues related to Humana’s Medicaid business partner operations areas and to recommend changes that assure compliance with regulatory and contractual obligations.

The Compliance Officer provides strategic guidance for the development and implementation of Humana’s Virginia Medicaid Compliance Program. The Compliance Officer is responsible for developing and implementing policies, procedures, and practices designed to ensure compliance with the requirements of the Contract. The Compliance Officer 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 Compliance Officer’s focus will be on preventing, detecting, and resolving compliance issues related to Humana’s Medicaid business partner operations areas and to recommend changes that assure compliance with regulatory and contractual obligations.

Key Responsibilities:

• Works within assigned areas to optimize business results

• Responsible for development and oversight of the Regulatory Compliance Committee

• Maintains key relationships with Humana operational leaders and our business partners

• Interprets and defines regulatory and Contract requirements for Humana departments and external business partners to implementation

• Provides ongoing oversight and monitoring of all Medicaid business operations to ensure full compliance and minimize risk for the enterprise

• Reviews and analyzes market documents and data to identify evidence of meeting regulatory standards

• Performs risk assessments, develops, and oversees corrective action plans, and provides guidance to operational groups

• Ability to travel up to 10% to VA State Capital and Louisville

Use your skills to make an impact
 

Required Qualifications

• Virginia residency required

• Bachelor’s degree in related field

• Advanced experience working in a Compliance-related or managed care-related field

• Knowledgeable in process improvement

• Knowledgeable in regulations governing health care industries

• Strong communication skills

Preferred Qualifications

• Juris Doctor and/or advanced degree

• Audit experience

• Experience with metrics and reporting

• Experience in Health Plan Compliance or Health Plan Operations

• Experience working with regulatory agencies, including state departments of health insurance and/or CMS

Additional Information

Work-At-Home Requirements:  

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:  

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule