Compliance Professional (Virginia Medicaid)

Become a part of our caring community and help us put health firstHumana Healthy Horizons in Virginia is seeking a Compliance Professional 2 who will lead incoming regulatory audits, coordinates audit responses, coordinates site visits for State and Federal agencies, and monitors corrective action plans, if applicable.

Research exam issues/requests and partners with subject matter experts to provide responses while obtaining the proper approvals.

Offers opportunity to influence the departments strategy by recommending updates to department procedures.

Receives audit requests from examiners, partners with Law, Risk, and Compliance subject matter experts to respond, and reviews the responses for accuracy and completeness.

Interacts with other professionals throughout the enterprise on significant healthcare compliance topics.

Conducts reviews of Critical Incidents to determine is designations and submissions are appropriate.

Responsible for monthly, quarterly, and annual Critical Incident (CI) reporting to the regulator.

Conducts mock audits of care coordination teams in preparation for regulatory audits or External Quality Review Organizations (EQROs) audits.

Supports multiple external audit requests performed by state Departments of Insurance and Federal agencies, such as Health and Human Services' Centers for Medicare and Medicaid Services (CMS) and EQROs.

Supports compliance oversight activities including compliance monitoring and overseeing implementation of policies/procedures and regulatory changes.

Reviews and monitors the organizations responses to audit requests and advise subject matter experts.

Monitors and reports on audit status to Law, Risk, and Compliance stakeholders.

Records audit information in internal Humana systems and external agency systems.

Use your skills to make an impactRequired Qualifications

Must reside in the commonwealth of Virginia or within a 40-mile radius from Virginia in a bordering state/district (Washington DC, MD, WV, KY, TN & NC) .

Bachelor's or associate degree.

Two (2) - five (5) years of healthcare or managed care experience.

Two (2) years of work-related experience (auditing, risk, compliance, regulatory or related experience).

Regulatory or Medicare/Medicaid compliance experience.

Auditing experience working with auditing functions within compliance or other related experience.

Preferred Qualifications

Professional certifications such as CPA, CIA, CISA, CISSP, CFA or PMP.

Certified Health Compliance (CHC) professional, Certified in Healthcare Privacy Compliance (CHPC) via HCCA.

Two (2) years of law, risk, compliance, internal audit, public audit, or project management experience.

Knowledge of Humana's cultural values, products, policies, and procedures.

Additional Information

Workstyle: This is a remote position with occasional travel.

Travel: Occasionally to Humana Healthy Horizons location in Glen Allen, VA for face-to-face meetings and on-site collaboration as well as to the Department of Medical Assistance Services (DMAS) for meetings.

Typical Workdays & Hours: Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST).

Work at Home Internet CriteriaTo ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.

Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview FormatAs part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.Scheduled Weekly Hours40Pay RangeThe 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.$57,700 - $79,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, 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.About usHumana 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 EmployerIt 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=HumanaWebsite.