Compliance Professional (Virginia Medicaid)

Become a part of our caring community and help us put health first
 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 …