Senior Compliance Professional

🔥 4 hours ago

🇺🇸 United States – Remote

💵 $86.3k - $118.7k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ 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

• ensures adherence to government regulations and requirements • analyze business requirements, conduct research, and provide regulatory interpretation • develop and implement monitoring and auditing plans for business processes • oversee pharmacy compliance for the Centers for Medicare & Medicaid Services (CMS) Program Audit focused areas • cultivate relationships with key partners to ensure compliance alignment on strategic initiatives • research, understand and apply laws, regulations, and regulatory guidance as applicable for pharmacy services • conduct risk assessments and perform auditing and monitoring activities • present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders • oversee development and progress of issue remediation

🎯 Requirements

• Bachelor's degree or three (3) years or more years of demonstrated experience in pharmacy and compliance • Three (3) or more years of experience in pharmacy operations and/or claims processing within a pharmacy setting • Two (2) or more years of experience in health plan compliance or health plan operations • Experience in pharmacy Coverage Determination, and Organization Determination (Part B drugs) functions • Experience working with regulatory agencies • Intermediate proficiency in Microsoft Excel, Word and PowerPoint • Knowledgeable in process improvement and metrics development • Knowledgeable in regulations governing health care industries • Strong communication skills to lead meetings and communicate with business partners • Proven ability to work independently, manage time effectively, and deliver results with minimal supervision.

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • paid time off • company and personal holidays • volunteer time off • paid parental and caregiver leave • short-term and long-term disability • life insurance • many other opportunities