Compliance Senior

1 week ago

Toronto, Ontario, Canada Humana Full time
Humana Senior Compliance Professional Madison , Wisconsin Apply Now
Become a part of our caring community and help us put health first

This Senior Compliance Professional role supports Humana's suite of Medicare and Commercial Dental and Vision products and ensures compliance with regulatory requirements, focusing on providers, contracting, credentialing, and networks.

The Senior Compliance Professional works assignments involving moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

For our Dental and Vision insurance products, the Senior Compliance Professional shall:
Develop and implement regulatory compliance policies and procedures
Research regulatory compliance issues and make business recommendations that assure compliance with regulatory and contractual obligations
Coordinate implementation and compliance with corrective action plans, as needed
Provide compliance guidance, direction, and compliance risk assessment to assigned business partners
Conduct periodic compliance reviews of business partner operations
Develop and monitor metrics and other oversight tools that indicate business area compliance
Recommend new measures of compliance performance, as well as risk governance controls
Make decisions on moderately complex to complex issues regarding technical approach for project components and be able to work without significant direction

The Senior Compliance Professional's primary focus will be to develop and implement a plan to monitor and audit business processes related to providers, contracting, credentialing, and the networks of Humana's Medicare and Commercial Dental and Vision products.

The primary goal will be to prevent, detect, and resolve compliance issues to help ensure an effective compliance program for the assigned products.

Serve as the subject matter expert for Medicare and Commercial Dental and Vision compliance issues related to providers, contracting, credentialing, and networks
Research, understand and apply laws, regulations, and regulatory guidance
Develop audit methodology and perform auditing and monitoring activity 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
Analyze business requirements and complex issues, conduct research, and provide regulatory guidance to business partners, Law, Risk, and Compliance associates and leaders with regard to Dental and Vision compliance issues
Develop and track compliance metrics to help monitor and detect potential compliance issues
Partner with Regulatory Compliance team members on regulatory outreach
Serve as a Regulatory Compliance subject matter expert for providers, contracting, credentialing, and networks of Humana's Dental and Vision products during external audits
Lead audit preparation and activity and perform oversight of business audit preparation to ensure timely, accurate and complete submission of required data and documentation to regulators
Present findings of monitoring and auditing efforts to business partners and Compliance leaders, as well as track issue to ensure appropriate and timely remediation
Lead and participate on committees, providing compliance guidance and direction
Provide back-up and support to other Compliance team members and perform other duties, as needed
Bachelor's degree in a related field
Advanced experience working in a Legal, Risk, or Compliance-related or healthcare-related field
Demonstrated ability to analyze regulatory requirements and assist business areas with understanding impacts of requirements on their operations
Demonstrated ability to utilize analytical skills and leverage data analytics to understand broad impacts of regulatory requirements and compliance risks
Strong attention to detail and focus on process and quality
High level of emotional intelligence
D. or other graduate degree
Knowledge/understanding of laws and regulations governed by CMS and/or various Departments of Insurance and other regulatory agencies
Experience with or knowledge of provider contracting, credentialing, and/or provider networks
Experience with metrics, KPIs, and other data analytics

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.

This incentive opportunity is based upon company and/or individual performance.

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.


NYSE:
HUM) is committed to putting health first - for our teammates, our customers and our company.

Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it.

These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran.

It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements.

This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion.

We also provide free language interpreter services.

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