Senior Compliance Professional

Humana • Louisville, KY

34d • Remote

About The Position

Become a part of our caring community and help us put health first The Senior Compliance Professional is responsible for ensuring adherence to governmental regulations and requirements. This role involves work assignments of moderate to high complexity, requiring comprehensive analysis and evaluation of variable factors and data. The primary focus of this position is compliance related to Medicare Pharmacy and Part D programs. The Senior Compliance Professional will analyze business requirements, conduct research, and provide regulatory interpretation to advise internal business units and external business partners. This guidance supports the delivery of results that minimize compliance risk exposure for the Company. The Senior Compliance Professional is also responsible for developing and maintaining key relationships with Humana operational leaders and external business partners. The primary focus of this role is to develop and implement monitoring and auditing plans for business processes, with the objective of preventing, detecting, and resolving compliance issues related to Humana’s pharmacy services across segments. While working within assigned areas to optimize business results, the Senior Compliance Professional will:
Cultivate relationships with key partners to ensure compliance alignment on strategic initiatives. Research, understand and apply laws, regulations, and regulatory guidance as applicable for pharmacy services across various segments. Conduct risk assessments and perform auditing and monitoring activities to prevent and detect issues of noncompliance and provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations. Develop and track compliance metrics to help monitor and detect potential compliance issues. Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders and track issues to ensure appropriate and timely remediation. Oversee development and progress of issue remediation; review and analyze documents and data to identify what can be used to evidence meeting regulatory standards. Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed. Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts. Support resolution of CMS inquiries including analyzing complaints, questions, and complex situations. Use your skills to make an impact

Requirements

• Bachelor’s degree in related field or equivalent work experience
• 2 plus years of experience in Health Plan Compliance or Health Plan Operations
• Experience working with regulatory agencies
• Knowledgeable in process improvement and metrics development
• Knowledgeable in regulations governing health care industries
• Strong communication skills
• 3 plus years of experience with pharmacy operations and/or claims processing in a pharmacy setting
• Intermediate Microsoft Excel, Word and PowerPoint proficiency
• Demonstrated ability to work independently

Nice To Haves

• Juris Doctor or Master of Business Administration
• Familiarity with Medicare pharmacy laws or regulations

Responsibilities

• Cultivate relationships with key partners to ensure compliance alignment on strategic initiatives.
• Research, understand and apply laws, regulations, and regulatory guidance as applicable for pharmacy services across various segments.
• Conduct risk assessments and perform auditing and monitoring activities to prevent and detect issues of noncompliance and provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations.
• Develop and track compliance metrics to help monitor and detect potential compliance issues.
• Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders and track issues to ensure appropriate and timely remediation.
• Oversee development and progress of issue remediation; review and analyze documents and data to identify what can be used to evidence meeting regulatory standards.
• Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed.
• Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts.
• Support resolution of CMS inquiries including analyzing complaints, questions, and complex situations.

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 and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior