Senior Compliance Professional

Become a part of our caring community and help us put health first
 The Senior Compliance Professional ensures compliance with governmental requirements. The Senior 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 Senior Compliance Professional role is responsible for ensuring the Clinical Operations department compliance with the Center of Medicare and Medicaid Services (CMS), National Committee of Quality Accreditation (NCQA), and local state Medicaid regulations. 

This role is responsible for developing and maintaining letter templates for Medicare and D-SNP utilization management business areas. Letter templates are created in accordance with state and Federal requirements. Attention to detail is crucial in this role to ensure determination tools are created accurately and efficiently. Excellent verbal and written communication skills are required in order to be successful in this role.  In this role, you will make decisions on moderately complex issues regarding technical approach for assigned projects.

Use your skills to make an impact
 

Responsibilities but not limited to:

• Creates, maintains, and updates member letter templates for Medicare and D-SNP Utilization Management decisions
• Tracks changes to state and federal regulations and to internal policies to ensure letters are updated timely

Required Qualifications

• Minimum 5 years of experience working in CGX
• Previous experience with Medicare and D-SNP Utilization Management
• Strong working knowledge of the UM Letters process
• Excellent communication skills, written and verbal
• Proficiency in all Microsoft Office including Word, Excel, PowerPoint, Outlook and Teams
• Detail-oriented
• Strong technical and analytical skills
• Self-starter with a high level of accountability
• Strong organizational and effective time management skills
• Ability to work cross-functionally to achieve results
• Strong problem-solving skills
• Ability to work independently under general instructions

Desired Qualifications

• Compliance experience researching federal and state regulations

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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
• Associates 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 associates 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

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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 yearThis 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:
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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.

---