29 applicants

Company

Humana · 5 hours ago

UM Compliance Analyst

Remote Mississippi

Full-time

Remote

Entry Level

$63K/yr - $87K/yr

1+ years exp

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H1B Sponsor Likely

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Responsibilities

Reviews and interprets new CMS and regulatory requirements and works with the business area to ensure compliance with requirements.

Manages tasks and timelines to ensure compliance with regulatory initiatives.

Conducts quality assurance audits of pre-service organization determinations to ensure compliance requirements and internal processes are being followed.

Generation and data scrubbing of CMS audit universes including source system validations.

Reviews and validates monthly compliance metrics and works with the business area to identify root cause and implement corrective action plan for any non-compliant metrics.

Works with the business area in updating policies and procedures.

Attends assigned compliance meetings and acts as the liaison between the HSO compliance team and Health Services business areas.

Coordinate special compliance projects and any additional tasks as determined by leadership.

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.

Compliance auditingData analysisMicrosoft ExcelHealthcare compliance certificationCMS regulations knowledgeProcess improvementBilingual EnglishBilingual SpanishUtilization management experience

Required

1 or more years of work experience in a compliance, auditing, and/or in a health plan working in the utilization management department.

1 or more years of managing departmental updates, process improvement and/or special projects.

1 or more years of experience with trending and analyzing data.

Comprehensive knowledge of Microsoft Outlook, Word and Excel

Preferred

Bachelor's Degree

Strong analytical and attention to detail skills.

Certification(s) relevant to compliance area of expertise, such as certification in healthcare compliance (CHC)

Prior Medicare health plan experience

Knowledge of CMS regulations pertaining to compliance in a managed care health plan

Bilingual (English and Spanish)

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

10,001+ employees

http://www.humana.com

H1B Sponsorship

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Trends of Total Sponsorships

2023 (217)

2022 (257)

2021 (258)

2020 (107)