Humana Hiring for Compliance Professional at Birmingham, Alabama Full Time

Description

Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.

Be a part of Compliance – Use your business knowledge and analytical skills to help analyze and develop policies, procedures and programs supporting our compliance initiatives. Humana is seeking a Compliance Professional 2 to analyze business and contract requirements, provide research and regulatory interpretation, perform auditing and monitoring, and coordinate with internal business units to deliver results in a manner that minimizes compliance risk exposure for the Company. As a Compliance Professional 2 for our Medicaid business, you will be part of a fast-growing team who develops and maintains key relationships with Humana operational leaders as well as externally with regulators and business partners.

Responsibilities

While working within assigned areas to optimize business results, you will:

• Interpret and define Medicaid regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners;

• Provide on-going oversight and monitoring of Medicaid business operations to ensure full compliance and minimize risk for the Enterprise;

• Review and analyze operational documents and data to identify what can be used to evidence meeting regulatory standards;

• Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts;

• Monitor a standard set of data/metrics relating to regulatory standards across markets;

• Perform risk assessments, audits, oversee action plans and provide guidance to operational groups to remediate issues;

• Build relationships with business partners;

• Participate in preparation for on-site audits, and other regulatory reviews as needed;

• Other special projects as assigned.

Role Essentials

• Bachelor’s degree in related field

• Experience working in a Compliance-related or managed care-related field or experience with regulatory agencies and compliance regulations

• Knowledgeable in process improvement and metrics development

• Knowledgeable in regulations governing health care industries

• Ability to manage multiple or competing priorities and meet deadlines

• Strong communication skills

• Strong attention to detail

Role Desirables

• Juris Doctor or Masters of Business Administration

• 3+ years of experience in Health Plan Compliance or Health Plan Operations

• Knowledge of or experience in managed Medicaid programs

Scheduled Weekly Hours

40

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. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.