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

The Sr. Compliance Professional ensures compliance with governmental requirements for clinics across both federal and state requirements. The Sr. Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

The Sr. Compliance Professional develops and/or evaluates compliance policies and procedures. Research compliance issues and recommends changes that assure compliance with federal and/or state requirements related to Provider Clinic operations, billing, investigations, and processes. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Participates in all phases of the audit process including evaluating control design and adequacy, testing to ensure adherence with established policies and internal controls, and communicating issues and recommendations to management. Coordinates implementation and compliance with corrective action plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. 

Job Responsibilities:

The Senior Compliance Professional serves as a regulatory compliance subject matter expert with the 2nd line of defense compliance function. Research compliance related issues and communicate those requirements to high level business leaders within the PCO.

Assesses the compliance risks to PCO and leverages the assessment to design the auditing and monitoring activities included in the workplan.  

Executes assigned portions of the PCO compliance workplan throughout the year.

Regularly conducts compliance related clinic investigations. Gathers and analyzes facts to make recommendations at the conclusion of the investigation.

Influence department strategy by identifying and overseeing the development of continuous monitoring activities. This role would also be the lead to help to develop risk analysis reporting for both the clinic compliance metrics, and M&A activity within the PCO.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree
• 2-4 years in Healthcare related field
• Experience conducting investigations
• Ability to manage multiple or competing priorities and meet deadlines
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Effective verbal and written communication skills
• Strong attention to detail
• Ability to articulate findings and impacts
• Knowledge/understanding of laws and regulations governed by the Department of Justice and CMS
• Knowledge of healthcare compliance, mainly primary care, hospital, and pharmacy knowledge

Preferred Qualifications

• Medicare Risk Adjustment Experience
• Clinical background preferred
• Compliance regulations knowledge and compliance auditing experience
• Ability to analyze large data sets
• Six Sigma or Lean Certified
• Graduate degree, MBA or Healthcare focus a plus
• Experience with metrics and reporting

Additional Information

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, ti