CenterWell PCO, Senior Compliance Professional - Remote - Humana
Honolulu, HI
About the Job
Become a part of our caring community and help us put health first
The Sr. Compliance Professional ensures compliance with governmental requirements for clinics across both federal and state requirements. The Sr. Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Sr. Compliance Professional develops and/or evaluates compliance policies and procedures. Research compliance issues and recommends changes that assure compliance with federal and/or state requirements related to Provider Clinic operations, billing, investigations, and processes. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Participates in all phases of the audit process including evaluating control design and adequacy, testing to ensure adherence with established policies and internal controls, and communicating issues and recommendations to management. Coordinates implementation and compliance with corrective action plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Job Responsibilities:
The Senior Compliance Professional serves as a regulatory compliance subject matter expert with the 2nd line of defense compliance function. Research compliance related issues and communicate those requirements to high level business leaders within the PCO.
Assesses the compliance risks to PCO and leverages the assessment to design the auditing and monitoring activities included in the workplan.
Executes assigned portions of the PCO compliance workplan throughout the year.
Regularly conducts compliance related clinic investigations. Gathers and analyzes facts to make recommendations at the conclusion of the investigation.
Influence department strategy by identifying and overseeing the development of continuous monitoring activities. This role would also be the lead to help to develop risk analysis reporting for both the clinic compliance metrics, and M&A activity within the PCO.
Use your skills to make an impact
Required Qualifications
+ Bachelor's degree
+ 2-4 years in Healthcare related field
+ Experience conducting investigations
+ Ability to manage multiple or competing priorities and meet deadlines
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
+ Effective verbal and written communication skills
+ Strong attention to detail
+ Ability to articulate findings and impacts
+ Knowledge/understanding of laws and regulations governed by the Department of Justice and CMS
+ Knowledge of healthcare compliance, mainly primary care, hospital, and pharmacy knowledge
Preferred Qualifications
+ Medicare Risk Adjustment Experience
+ Clinical background preferred
+ Compliance regulations knowledge and compliance auditing experience
+ Ability to analyze large data sets
+ Six Sigma or Lean Certified
+ Graduate degree, MBA or Healthcare focus a plus
+ Experience with metrics and reporting
Additional Information
Scheduled Weekly Hours
40
Pay Range
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. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$86,300 - $118,700 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of 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.
Application Deadline: 01-29-2025
About us
Humana Inc. (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.
Equal Opportunity Employer
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 veteran status. It is also the policy of Humana to 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. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
The Sr. Compliance Professional ensures compliance with governmental requirements for clinics across both federal and state requirements. The Sr. Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Sr. Compliance Professional develops and/or evaluates compliance policies and procedures. Research compliance issues and recommends changes that assure compliance with federal and/or state requirements related to Provider Clinic operations, billing, investigations, and processes. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Participates in all phases of the audit process including evaluating control design and adequacy, testing to ensure adherence with established policies and internal controls, and communicating issues and recommendations to management. Coordinates implementation and compliance with corrective action plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Job Responsibilities:
The Senior Compliance Professional serves as a regulatory compliance subject matter expert with the 2nd line of defense compliance function. Research compliance related issues and communicate those requirements to high level business leaders within the PCO.
Assesses the compliance risks to PCO and leverages the assessment to design the auditing and monitoring activities included in the workplan.
Executes assigned portions of the PCO compliance workplan throughout the year.
Regularly conducts compliance related clinic investigations. Gathers and analyzes facts to make recommendations at the conclusion of the investigation.
Influence department strategy by identifying and overseeing the development of continuous monitoring activities. This role would also be the lead to help to develop risk analysis reporting for both the clinic compliance metrics, and M&A activity within the PCO.
Use your skills to make an impact
Required Qualifications
+ Bachelor's degree
+ 2-4 years in Healthcare related field
+ Experience conducting investigations
+ Ability to manage multiple or competing priorities and meet deadlines
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
+ Effective verbal and written communication skills
+ Strong attention to detail
+ Ability to articulate findings and impacts
+ Knowledge/understanding of laws and regulations governed by the Department of Justice and CMS
+ Knowledge of healthcare compliance, mainly primary care, hospital, and pharmacy knowledge
Preferred Qualifications
+ Medicare Risk Adjustment Experience
+ Clinical background preferred
+ Compliance regulations knowledge and compliance auditing experience
+ Ability to analyze large data sets
+ Six Sigma or Lean Certified
+ Graduate degree, MBA or Healthcare focus a plus
+ Experience with metrics and reporting
Additional Information
Scheduled Weekly Hours
40
Pay Range
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. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$86,300 - $118,700 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of 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.
Application Deadline: 01-29-2025
About us
Humana Inc. (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.
Equal Opportunity Employer
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 veteran status. It is also the policy of Humana to 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. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana