Compliance Professional 2-WAH in US

Profile

Description

The Compliance Professional 2 (CP2) develops and implements compliance policies and procedures, researches compliance issues and recommends changes that ensure Humana is compliant with contractual obligations with a focus on fraud, waste and abuse reporting; the CP2 also develops and nurtures relationships with government agencies.

Responsibilities

The hours are Mon-Fri 8am-5pm EST.

Key Responsibilities:

Government Fraud, Waste & Abuse Reporting and Referrals (As assigned by Senior Compliance Professional of Government FWA Reporting Team)

Compile, review and submit required FWA Program Integrity reports and referrals to state and federal regulatory agencies in accordance with all deadlines. This includes preparing reports ahead of time to ensure they are reviewed by appropriate leaders prior to submission.

Ability to request data needed for reports and know how to analyze it

Review Federal and state laws and regulations, contractual requirements and company policies to ensure all reporting needs are met.

Department of Insurance (DOI) research for fraud reporting specifications

Contract review for compliance requirements

Assist with CCM Risk Document maintenance to identify all compliance risk items for CCM (Claims Cost Management)

Oversight of Compliance requirements to ensure audit readiness

Additional needs as assigned by the CCM Compliance Team Manager and/or the CCM Senior Compliance Professional

Required Qualifications

Associate's degree

2 years data analysis experience

Advanced understanding of tools such as Excel (pivot tables, vLookups, sorting), Word, PowerPoint, SharePoint, etc .

Excellent communication skills - both written and verbal

Attention to detail and organizational skills

Collaboration and teamwork skills

Multi-tasking and time management skills

Preferred Qualifications

Bachelor or Advanced degree

Experience working with healthcare data

Knowledge of CCM (Claims Cost Management) business areas

Experience building reports to track program compliance metrics and presenting data to leadership

Experience reading and interpreting legislation and policy documents

Knowledge of state Medicaid contracts

Additional Information

Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.

Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com