Be an early applicantLess than 25 applicants

Company

Humana · 5 days ago

CenterWell PCO, Senior Compliance Professional - Remote

Kentucky, United States

Full-time

Remote

Mid, Senior Level

$85K/yr - $116K/yr

2+ years exp

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H1B Sponsor Likely

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Responsibilities

The Senior Compliance Professional serves as a regulatory compliance subject matter expert with the 2nd line of defense compliance function.

Research compliance related issues and communicate those requirements to high level business leaders within the PCO.

Assesses the compliance risks to PCO and leverages the assessment to design the auditing and monitoring activities included in the workplan.

Executes assigned portions of the PCO compliance workplan throughout the year.

Regularly conducts compliance related clinic investigations.

Gathers and analyzes facts to make recommendations at the conclusion of the investigation.

Influence department strategy by identifying and overseeing the development of continuous monitoring activities.

This role would also be the lead to help to develop risk analysis reporting for both the clinic compliance metrics, and M&A activity within the PCO.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Healthcare complianceLaws/regulationsMedicare Risk AdjustmentCompliance auditingData analysisSix Sigma CertifiedLean CertifiedGraduate degreeMetrics

Required

Bachelor's degree

2-4 years in Healthcare related field

Experience conducting investigations

Ability to manage multiple or competing priorities and meet deadlines

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Effective verbal and written communication skills

Strong attention to detail

Ability to articulate findings and impacts

Knowledge/understanding of laws and regulations governed by the Department of Justice and CMS

Knowledge of healthcare compliance, mainly primary care, hospital, and pharmacy knowledge

Preferred

Medicare Risk Adjustment Experience

Clinical background preferred

Compliance regulations knowledge and compliance auditing experience

Ability to analyze large data sets

Six Sigma or Lean Certified

Graduate degree, MBA or Healthcare focus a plus

Experience with metrics and reporting

Benefits

Medical

Dental and vision benefits

401(k) retirement savings plan

Paid time off

Company and personal holidays

Volunteer time off

Paid parental and caregiver leave

Short-term and long-term disability

Life insurance

Company

Humana

Glassdoor

3.8

Humana is a health insurance provider for individuals, families, and businesses.

Founded in 1964

Louisville, Kentucky, USA

10001+ employees

http://www.humana.com

H1B Sponsorship

Humana has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2023 (217)

2022 (257)

2021 (258)

2020 (107)