Naba Senior Compliance Professional

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NABA Senior Compliance Professional
Duties: The candidate will provide guidance for the development and implementation of Humana’s Oklahoma Medicaid Compliance Program. Serve as the primary point of contact for all Managed Care Organization (MCO) communications regarding compliance issues. Ensure that written policies, procedures, and standards are in compliance with requirements set forth in the Contract. Analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. Provide guidance for the development and implementation of Humana’s Oklahoma Medicaid Compliance Program. Maintain key relationships both internally with Humana operational leaders as well as externally with our business partners, the State Medicaid Office and/or the Centers for Medicare and Medicaid Services (CMS) Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners; Provide on-going oversight and monitoring of all Medicaid business operations to ensure full compliance and minimize risk for the Enterprise; Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards; Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts. Coordinate and manage a standard set of data relating to regulatory standards. Perform risk assessments, develop and oversee action plans, and provide guidance to operational groups; Serve as a translator between Humana business leaders and State and Federal Medicaid Departments assisting with the interpretation of the intention of the guidelines; Coordinate day-to-day interaction with outside regulators as necessary; Act as a key participant in both on and offsite external audits, working with the regulators, as necessary.

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