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The Senior Compliance Professional ensures compliance with governmental requirements. The Senior 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 Senior Compliance Professional develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Begins to influence department’s strategy. 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.

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Senior Compliance Professional

• Job Description SummaryThe Senior Compliance Professional ensures compliance with governmental requirements. The Senior 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.
• Job Description

  The Senior Compliance Professional develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Begins to influence department’s strategy. 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.

  • Manage, Organize and Monitor the internal Humana Ohio Medicaid mailbox
  • Create reports, spreadsheets and Power Point presentations
  • Execute intake and tracking process and ensure changes are centrally documented in the Regulatory Repository
  • Coordinate and compose time sensitive responses to incoming regulatory inquiries and issues reflective of compliance with program requirements
  • Collaborate with internal business owners to ensure accurate and timely delivery of documents, including reports, prior to submission to regulatory agencies
  • Develop and maintain schedules of state and Federal deadlines and deliverables and ensure timely submission of accurate deliverables
  • Provide interpretation and guidance to the organization in regard to regulatory requirements and government contract administration
  • Lead the communication of annual and interim contract amendments in conjunction with appropriate business owners
  • Interact with regulators within the scope of responsibilities
  • Participate in Regulatory audits and site visits
  • Works collaboratively to develop and deliver compliance training programs, ensuring organizational workforce are knowledgeable of applicable laws
  • Establish and maintain collaborative working relationship with assigned regulatory agency and other key industry stakeholders.
  • Develop and maintain relationships with key internal and external stakeholders to ensure successful collaboration
  • Identify and recommend performance improvement opportunities
  • Report potential risks, non-compliance or alleged violations to Leadership.

  Required Qualifications

  • Bachelor's degree
  • PMP Certification and experience
  • 3-5 or more years of managed care
  • 5 or more years of technical experience
  • Knowledge/understanding of laws and regulations governed by the Ohio Department of Medicaid and CMS

  Preferred Qualifications

  • Advanced or graduate degree
  • Compliance and Risk Management experience
  • Audit or consulting experience
  • Experience with metrics and reporting
  • Well organized
  • Ability to work independently and multi-task with efficiency

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

  To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must m