Compliance Professional

Become a part of our caring community and help us put health first
 Humana Healthy Horizons is hiring a Compliance Professional who will support efforts for overall Medicaid Implementation by joining the team overseeing the facilitation of the Business Readiness Validation (BRV) process. The BRV is a key component of implementation that provides a methodical approach to confirm that critical processes, enabled by tested platforms and trained associates, are working as intended and gaps are prospectively identified prior to Medicaid go-live.

This is a fully remote, work from home position.

The Business Readiness Validation (BRV) Compliance Professional works to ensure readiness for Medicaid implementations. The Compliance Professional will work collaboratively with business partners to assess readiness and escalate issues. This is a fully remote, work from home position.

Key responsibilities for this role include:

• Working with business, IT and market teams to determine highest risk areas for BRV.
• Assisting in creation of BRV scenarios and working with team of determining success criteria.
• Collecting BRV data and scoring/analyzing according to success criteria.
• Escalating to management identified risks such as system defects, process or training errors, etc.
• Assisting in coordinating sign off and attestation from leaders to confirm readiness.
• Other related activities, as assigned by management.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's Degree.
• 2+ years of project management experience.
• 2+ years of proven experience in an audit, compliance, or regulatory role in health insurance.
• Medicaid experience.
• Demonstrated organizational skills, ability to simultaneously work on multiple projects at once, and ability to ensure deliverables are timely and accurate.
• Demonstrated ability in building and maintaining positive cross-functional relationships and facilitating and consulting across teams.

Preferred Qualifications

• Advanced or graduate degree.
• Certification such as a Certified Public Accountant, Certified Information Systems Auditor, or Certified Internal Auditor, Project Management certification, Healthcare Compliance Certification, etc.
• Medicaid health care insurance compliance/regulatory experience.
• Solid understanding of Humana's operations, technology, communications, processes and interconnectivity between them.
• Experience interpreting Medicaid contracts.
• Residing in the Eastern or Central time zones preferred.

 Work at Home Requirements

To 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 …