Compliance Professional 2

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist in compliance activities for Medicare and Medicaid concerning Payment Integrity, with an emphasis on financial recovery processes.

• Oversee business operations to ensure adherence to regulatory, contractual, and internal compliance standards.

• Detect noncompliance issues and coordinate mitigation efforts and follow-up actions.

• Conduct compliance reviews, monitoring, and reporting activities.

• Act as a liaison between Compliance and CAPI business partners.

• Evaluate compliance data, trends, and process results to pinpoint risks and opportunities for improvement.

• Aid in corrective action planning and remediation efforts with cross-functional teams.

• Keep documentation, reporting, and audit-ready materials up to date.

• Contribute to the development and implementation of the Payment Integrity Compliance framework.

• Recognize and promote opportunities for process enhancement and automation.

• Oversee assigned projects and their deliverables.

• Provide team support and coverage for compliance monitoring and financial recovery operations.

• Report to the Manager, Compliance.

⛳️ Requirements

• At least 2 years of experience in compliance or familiarity with Medicare and Medicaid federal regulations.

• Experience in Payment Integrity.

• Background in managing project-based assignments.

• Intermediate skills in Microsoft Word and Excel.

• Excellent analytical, organizational, and communication abilities.

• Must reside within the contiguous United States.

• Knowledge of Humana’s Payment Integrity Financial Recovery business teams and processes is preferred.

• Experience in creating and managing dashboards for compliance monitoring and reporting is preferred.

• Familiarity with advanced data manipulation and analysis is preferred.

• Proficiency in using pivot tables and related Excel reporting tools is preferred.

• Must fulfill work-from-home internet requirements: a minimum of 25 Mbps download and 10 Mbps upload.

• Must work from a dedicated space free from interruptions to safeguard member PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on individual and/or company performance.

• Medical, dental, and vision coverage.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability benefits.

• Life insurance coverage.

• Work-from-home arrangements.

• Flexible start time between 6 am and 9 am, depending on business needs.