Senior Compliance Professional

Employment Type: Full-time

Position Overview

Become a part of our caring community and help us put health first. The Senior Compliance Professional ensures compliance with governmental requirements. The work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The focus of this role is Medicare Pharmacy and Part D.

The Senior Compliance Professional will 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. The Senior Compliance Professional also develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners.

The Senior Compliance Professional’s primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues related to Humana’s pharmacy services across segments.

Responsibilities

While working within assigned areas to optimize business results, you will:

• Cultivate relationships with key partners to ensure compliance alignment on strategic initiatives.
• Conduct risk assessments and perform auditing and monitoring activities to prevent and detect issues of noncompliance.
• Provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations.
• Develop and track compliance metrics to help monitor and detect potential compliance issues.
• Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders and track issues to ensure appropriate and timely remediation.
• Oversee development and progress of issue remediation.
• Review and analyze documents and data to identify what can be used to evidence meeting regulatory standards.
• Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed.
• Support resolution of CMS inquiries including analyzing complaints, questions, and complex situations.
• Use your skills to make an impact.

Required Qualifications

• Bachelor’s degree in a related field or 5 or more years' experience working in a Compliance-related or managed care-related field or pharmacy.
• Experience working with regulatory agencies.
• Knowledgeable in process improvement and metrics development.
• Knowledgeable in regulations governing health care industries.
• Strong communication skills.
• Experience with pharmacy operations and/or claims processing in a pharmacy setting.
• Intermediate Microsoft Excel, Word, and PowerPoint proficiency.
• Demonstrate the ability to research, understand, and apply laws, regulations, and regulatory guidance as applicable for pharmacy services across various segments.
• Demonstrate the ability to work across operational units and product lines to enhance data analytics and operational improvement efforts.

Preferred Qualifications

• Juris Doctor or Master of Business Administration.
• 3 plus years of experience in Health Plan Compliance or Health Plan Operations.
• Familiarity with Medicare pharmacy laws or regulations.

Additional Information

Interview Format: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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