Compliance Professional 2 - Medicaid

Description

Responsibilities

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.

Assignment Capsule

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.

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 working with regulatory agencies  
• 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 Master of Business Administration
• 3 years of experience in Health Plan Compliance or Health Plan Operations
• Knowledge of or experience with managed Medicaid programs

Additional Information

Vaccine Policy:

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health-screening questionnaire.  

Work-At-Home Requirements:

• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.  
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Why Humana?  You'll experience the following perks as a full-time Humana employee:

Compensation and Financial Security — Our pay philosophy is designed to motivate and reward associates for their skills and contributions to the company. We provide options to help you plan for your future and protect your assets: Competitive base pay, Recognition pay, 401(k) retirement savings plan (125% match for the first 6% contributed by an associate), etc.

Your Whole Health — Humana's health products and services are designed to encourage personal wellness and smart healthcare decisions for you and your family: Medical, dental, and vision benefits, Health plan incentives, Paternity leave, etc.

Work Perks — Humana knows your life extends outside of work. We have many options to support your interests and needs. Some departments have the flexibility to allow associates to work from home, and we offer all associates: Paid time off, holidays, volunteer time, jury duty pay, Associate charity matching program, Discount programs with major retailers, etc.

Grow With Us — Humana provides growth and career opportunities that can help you develop your skills and build your future with the organization: Internal and external learning events, Tuition assistance, Inclusion and diversity training, etc.

Social Security Task:

Alert: Humana values personal identity protection.  Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file.  When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana’s secure website.  

Interview Format:

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 receive a set of interview questions over your phone and you will provide recorded or text message responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

More info on Why Humana.

Why Humana?

At Humana, we know your well-being is important to you, and it’s important to us too.  That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. Just to name a few:

• Work-Life Balance
• Generous PTO package
• Health benefits effective day 1
• Annual Incentive Plan
• 401K - Immediate company match
• Well-being program 
• Paid Volunteer Time Off
• Student Loan Refinancing

If you share our passion for helping people, we likely have the right place for you at Humana.

COMPANY OVERVIEW

For more than 60 years, Humana has been a proven leader and innovator in the health and wellness industry. A passionate emphasis on people, choice, well-being, and innovation guide our business practices and culture. We're not just a health insurance company. Our diverse lines of business position us to serve millions of people with a wide range of needs, including seniors, military members, and self-employed individuals.

If you're looking for a career that provides opportunities for growth and development in a stable industry, Humana might be the right fit for you.

60 — We have been committed to seniors' health and care for nearly 60 years.

46K — We have 46,000 associates.

#56 — Ranked #56 on the Fortune 500 list in 2019.

16.6M — We have 16.6 million medical members across all 50 states.

12M — Since 2001, we have awarded more than $12 million in scholarships to children of Humana associates.

Scheduled Weekly Hours