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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 Senior Compliance Professional serves as the dedicated Compliance Officer for Virginia to 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. As a Senior Compliance Professional for our Medicaid business, you will be part of a fast-growing team who develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners and oversight agencies.  While working within assigned areas to optimize business results, you will:

• Serves as dedicated Regulatory Compliance Officer for Virginia Medicaid contract.
• Build relationships with market leadership teams and external regulators;
• Provide ongoing oversight of Medicaid operations from readiness review through contract duration to ensure full compliance and minimize risk for the Enterprise;
• Perform risk assessments, develop and implement annual regulatory compliance auditing and monitoring work plans, oversee corrective action plans and document remediation activities. 
• Interpret and define state and federal regulatory and contract requirements for Humana Departments and/or external business partners and provide ongoing guidance. 
• Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards;
• Participate in external audits to review document submissions, prepare presenters, and coordinate responses for regulators, as necessary;
• Work across Humana operational units and product lines to enhance compliance data analytics and operational improvement efforts;
• Coordinate and manage a standard set of data relating to regulatory standards and report compliance issues to senior leadership and compliance oversight committees.
• Chair the <assigned state> Compliance Committee per approved charter;
• Coordinate compliance related communication/interaction with outside regulators, as necessary.
• Coordinate with the Special Investigations Unit (SIU) to operate and effective fraud, waste and abuse program integrity program. 

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 or Medicaid
• 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 working with regulatory agencies, including state departments of health insurance and/or CMS
• Knowledgeable in process improvement

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 me