Work Location(s): Orlando, FL, US
Overland Park, KS
Las Vegas, NV
San Antonio, TX
The Senior Compliance Professional will work with Humana Care Delivery Organization’s internal business partners to oversee and track compliance issues, trend data, prepare regular reporting, provide compliance support to CDO business owners, and manage oversight of project deadlines for new plan year initiatives. The Senior Compliance Professional will assist the Compliance Manager in managing the Compliance Program and providing support for external audits. The Senior Compliance Professional will be responsible for drafting internal and external communications regarding compliance issues and remediation, advising CDO business owners on issues with compliance implications, and represents the Compliance Department in multi-departmental initiatives.
This position will report directly to the Compliance Manager.
The Senior Compliance Professional develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Senior Compliance Professional will:
- Manages compliance program oversight of the business by driving auditing and monitoring activities, providing compliance guidance to the business, and tracking relevant laws and regulations and staying current on changes impacting healthcare compliance.
- Prepares compliance reports, guidance memoranda, and data analytics for internal senior management, or regulatory agencies as required.
- Ensures that project/department milestones/goals are met.
- Contributes to annual and longer-range development and implementation of company’s compliance risk assessment plans and compliance work plans.
- Proactively identifies and addresses compliance issues, and effectively integrates compliance risks/issues and business knowledge to address compliance issues and/or identified risks.
- Leads and/or participates, with limited direction, in cross-functional internal committees, and can represent the Compliance Department on cross-functional review/decision-making committees of significant impact across the organization.
- Develop and provide compliance training;
- Assist compliance management and senior leaders with federal, state, and/or administrative disclosure requirements;
- Reviews data to determine instances of suspected fraud, waste, and abuse;
- Where applicable, manages outside vendors to ensure on-time, on-target, and within-budget deliverables; and
- Assists with other Compliance Department duties and/or projects as assigned.
- Knowledge/understanding of laws and regulations governed by the Department of Insurance and CMS
- 4 or more years of work experience in healthcare compliance, corporate compliance, healthcare policy, legal, or relevant field.
- Bachelor’s Degree in a relevant field such as health sciences, law, public policy, healthcare administration, or related discipline.
- Healthcare Compliance Certification (before or w/in 12 months of hire).
- Excellent verbal and written business communication skills;
- Proven ability to synthesize and summarize complex and/or voluminous content into clear, concise and actionable communications;
- Works well within teams;
- Can effectively identify, develop, and implement process improvements to achieve department efficiencies and increase compliance program effectiveness;
- Excellent in building and cultivating relationships with key business partners and stakeholders across organizational levels;
- Thinks “outside of the box” for solutions. Applies creative problem-solving and appropriate business solutions to effectively address compliance risk;
- Excellent project management skills: can prioritize multiple tasks and goals to ensure timely, on-target and within-budget accomplishment of such;
- Demonstrates ability to identify appropriate resources. Exercises good judgment in terms of when to leverage internal resources;
- Excellent business acumen: understands how the business works and demonstrates consistently effective “navigation” across the organization;
- Must demonstrate in-depth knowledge of the legal and regulatory environment, as it relates to healthcare compliance in Medicare, Medicaid, and clinical industries (includes anti-kickback and Stark statutes, government fraud, waste, and abuse, false claims, etc.);
- Demonstrates intermediate computer skills including Microsoft Office suite of software applications in Excel and PowerPoint.
- Ability to travel to the various clinic locations.
- Previous experience in Medicare & Medicaid, Medicare Advantage, or government oversight strongly preferred.
- Graduate or advanced degree
- Audit or consulting experience
- Experience with metrics and reporting
- Experience in health care compliance, clinical, health information management (HIM), coding, auditing, investigations, or related work experience required.
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Modern Hire interview. In this interview, you will read to a set of interview questions and you will enter/text responses to each question. You should anticipate this interview to take about 10 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
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Scheduled Weekly Hours
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