Compliance Professional 2

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $65k - $88.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚔 Compliance

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Support Medicare and Medicaid compliance activities related to Payment Integrity, focusing on financial recovery processes • Monitor business operations for regulatory, contractual, and internal compliance • Identify noncompliance incidents and coordinate mitigation and follow-up • Perform compliance reviews, monitoring, and reporting • Liaise between Compliance and CAPI business partners • Analyze compliance data, trends, and process outcomes to identify risks and improvement opportunities • Support corrective action planning and remediation with cross-functional teams • Maintain documentation, reporting, and audit-ready materials • Assist with development and execution of the Payment Integrity Compliance framework • Identify and support process improvement and automation opportunities • Manage assigned projects and deliverables • Provide team support and coverage for compliance monitoring and financial recovery operations • Report to the Manager, Compliance

🎯 Requirements

• Minimum of 2 years of experience in compliance or with Medicare and Medicaid federal regulations • Payment Integrity experience • Experience managing project-based work • Intermediate proficiency in Microsoft Word and Excel • Strong analytical, organizational, and communication skills • Must be located within the contiguous United States • Knowledge of Humana’s Payment Integrity Financial Recovery business teams and processes (preferred) • Experience creating and managing dashboards for compliance monitoring and reporting (preferred) • Experience performing advanced data manipulation and analysis (preferred) • Proficiency using pivot tables and related Excel reporting tools (preferred) • Must meet work-from-home internet requirements: minimum 25 Mbps download and 10 Mbps upload • Must work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental, and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Work-from-home arrangement • Flexible start time between 6am and 9am, depending on business needs