Compliance Professional (Virginia Medicaid)
Work at Home - Virginia
Humana Healthy Horizons in Virginia is seeking a Compliance Professional 2 who will lead incoming regulatory audits, coordinates audit responses, coordinates site visits for State and Federal agencies, and monitors corrective action plans, if applicable.
- Research exam issues/requests and partners with subject matter experts to provide responses while obtaining the proper approvals.
- Offers opportunity to influence the departments strategy by recommending updates to department procedures.
- Receives audit requests from examiners, partners with Law, Risk, and Compliance subject matter experts to respond, and reviews the responses for accuracy and completeness.
- Interacts with other professionals throughout the enterprise on significant healthcare compliance topics.
- Conducts reviews of Critical Incidents to determine is designations and submissions are appropriate.
- Responsible for monthly, quarterly, and annual Critical Incident (CI) reporting to the regulator.
- Conducts mock audits of care coordination teams in preparation for regulatory audits or External Quality Review Organizations (EQROs) audits.
- Supports multiple external audit requests performed by state Departments of Insurance and Federal agencies, such as Health and Human Services' Centers for Medicare and Medicaid Services (CMS) and EQROs.
- Supports compliance oversight activities including compliance monitoring and overseeing implementation of policies/procedures and regulatory changes.
- Reviews and monitors the organizations responses to audit requests and advise subject matter experts.
- Monitors and reports on audit status to Law, Risk, and Compliance stakeholders.
- Records audit information in internal Humana systems and external agency systems.
Use your skills to make an impact
Required Qualifications
- Must reside in the commonwealth of Virginia or within a 40-mile radius from Virginia in a bordering state/district (Washington DC, MD, WV, KY, TN & NC).
- Bachelor’s or associate degree.
- Two (2) – five (5) years of healthcare or managed care experience.
- Two (2) years of work-related experience (auditing, risk, compliance, regulatory or related experience).
- Regulatory or Medicare/Medicaid compliance experience.
- Auditing experience working with auditing functions within compliance or other related experience.
Preferred Qualifications
- Professional certifications such as CPA, CIA, CISA, CISSP, CFA or PMP.
- Certified Health Compliance (CHC) professional, Certified in Healthcare Privacy Compliance (CHPC) via HCCA.
- Two (2) years of law, risk, compliance, internal audit, public audit, or project management experience.
- Knowledge of Humana’s cultural values, products, policies, and procedures.
Additional Information
- Workstyle: This is a remote position with occasional travel.
- Travel: Occasionally to Humana Healthy Horizons location in Glen Allen, VA for face-to-face meetings and on-site collaboration …
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Benefits/PerksBonus incentive plan Competitive benefits Dental Life Insurance Medical Paid parental and caregiver leave Paid Time Off Parental and Caregiver Leave Personal holidays Remote position Time off Vision Vision Benefits Volunteer time Volunteer time off Work From Home
Tasks- Compliance
- Project management
- Reporting
- Research
- Training
Auditing BI Business Care Coordination Collaboration Compliance Healthcare Healthcare Compliance HIPAA Human services Leadership Managed Care Medicaid Medicare PMP Project Management Recruitment Reporting Research Risk Management Strategy Teams Technology Training Wellness
Experience2-5 years
EducationAssociate degree Bachelor's degree Business Education Healthcare Human Services Management
Certifications TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9