NABA Senior Compliance Professional

Profile

NABA Senior Compliance Professional

The candidate will provide guidance for the development and implementation of the company's Oklahoma Medicaid Compliance Program. Will 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. Maintain key relationships both internally with company operational leaders as well as externally with 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 company 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 company 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 company 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. Should have a Bachelor's degree in a related field. Should preferably have a J.D. or an MBA degree. Should preferably have 3+ years of experience in health plan compliance or health plan operations. Advanced experience working in a Compliance-related or managed care-related field is required. Experience working with regulatory agencies, including state departments of health insurance and/or CMS is needed. Knowledge of process improvement and metrics development is essential. Knowledge of regulations governing health care industries is a must.

Additional Information

Requisition ID: R-249209

Company info

Humana Inc.
500 West Main Street
Louisville
Kentucky
United States 40202
Website : http://www.humana.com