Become a part of our caring community and help us put health first
 

The Senior Compliance Professional will ensure that Humana’s Specialty Organization (Dental) is compliant with all state and federal regulations as it relates to dental providers and dental networks.

The Senior Compliance Professional will ensure that Humana’s Specialty Organization (Dental) is compliant with all state and federal regulations as it relates to dental providers and dental networks.  This includes taking the lead in ensuring there are written procedures and policies that are reviewed and updated as needed to be consistent with all regulations.  This also includes responding to all state inquiries based on the regulatory timeframes.  This role will integrate with internal partners, such as operations and compliance to ensure that all internal processing and operational policies are consistent with appropriate regulations and support approved policies and procedures.

• Create a library of all Policies and Procedures regarding dental recruitment/dental networks by established deadline.
• Identify all compliance requirements and implement processes to deliver data to the compliance area on agreed upon timeframes.  This includes but is not limited to; appointment availability, access monitoring, access plans, provider surveys, etc.
• Collaborate with the various members of the compliance/regulatory areas, dental network, network analytics, and other areas to develop processes that meet compliance standards and are specific to dental.
• Assess Dental Compliance needs and create a budget for the collection of data and submissions of filings by established deadlines.
• Lead various cross functional teams, as directed by leadership, for compliance projects as they become known
• Conduct quality audits for processes within the Dental Network Area on a quarterly basis

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree or equivalent work experience
• 3+ years in Dental Healthplan Experience
• 5+ years of technical experience – policy writing, analytical skills, collaboration skills
• Strong communications skills and the ability to speak to differences between medical and dental regulations
• Knowledge/understanding of laws and regulations pertaining to dental governed by the Department of Insurance and CMS
• Ability to work under pressure and meet deadlines
• Critical Thinking and analytical skills
• Strong desire to understand compliance related topics and the ability research for discovery of compliance related topics
• MS Office Skills (Excel, Word), Sharepoint

Preferred Qualifications

• Graduate or advanced degree
• Lean Six Sigma
• Audit or consulting experience
• Experience with metrics and reporting

Additional Information

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

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Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$84,600 - $116,300 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company