Compliance Professional -Medicaid

Humana

2d • $65,000 - $88,600 • Remote

About The Position

Humana Healthy Horizons in Virginia is seeking a Compliance Professional who will assist with incoming regulatory inquiries/requests, coordinates inquiry responses, coordinates site visits for State and Federal agencies, and monitors corrective action plans, if applicable. This role involves researching regulatory issues/requests and partnering with subject matter experts to provide responses while obtaining the proper approvals. It offers an opportunity to influence the department's strategy by recommending updates to department procedures.

Requirements

• Must reside in the commonwealth of Virginia or within a 40-mile radius from Virginia in a bordering state/district (Washington DC, MD, WV, KY, TN & NC)
• Bachelor’s or associate degree
• Two (2) – five (5) years of healthcare or managed care experience
• Two (2) years of work-related experience (auditing, risk, compliance, regulatory or related experience)
• Regulatory or Medicare/Medicaid compliance experience
• Auditing experience working with auditing functions within compliance or other related experience

Nice To Haves

• Professional certifications such as CPA, CIA, CISA, CISSP, CFA or PMP
• Certified Health Compliance (CHC) professional, Certified in Healthcare Privacy Compliance (CHPC) via HCCA
• Two (2) years of law, risk, compliance, internal audit, public audit, or project management experience
• Knowledge of Humana’s cultural values, products, policies, and procedures

Responsibilities

• Assist with incoming regulatory inquiries/requests
• Coordinate inquiry responses
• Coordinate site visits for State and Federal agencies
• Monitor corrective action plans, if applicable
• Research regulatory issues/requests and partner with subject matter experts to provide responses while obtaining the proper approvals
• Recommend updates to department procedures
• Receive inquiries/requests from state partners with Law, Risk, and Compliance subject matter experts to respond
• Review responses for accuracy and completeness
• Interact with other professionals throughout the enterprise on significant healthcare compliance topics
• Assist with reviews of Critical Incidents to determine if designations and submissions are appropriate
• Responsible for monthly, quarterly, and annual Critical Incident (CI) reporting to the regulator
• Support multiple external regulatory requests performed by state Departments of Insurance and Federal agencies, such as Health and Human Services' Centers for Medicare and Medicaid Services (CMS) and EQROs
• Support compliance oversight activities including compliance monitoring and overseeing implementation of policies/procedures and regulatory changes
• Review and monitor the organization's responses to audit requests and advise subject matter experts
• Monitor and report on audit status to Law, Risk, and Compliance stakeholders
• Record regulatory request information in internal Humana systems and external agency systems

Benefits

• Medical benefits
• Dental benefits
• Vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• Short-term disability
• Long-term disability
• Life insurance
• Bonus incentive plan

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees