Sr. Compliance Professional

Kentucky, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Candidates must possess a Bachelor's degree and a minimum of 5 years of experience in healthcare compliance, including cross-functional collaboration in areas such as claims, privacy, and provider contracting. A strong understanding of laws and regulations from the Kentucky Department for Medicaid Services, Kentucky Department of Insurance, and CMS is required, along with intermediate or advanced proficiency in MS Office Suite (Word, Excel). The ability to apply laws, regulations, and contracts to daily business solutions, excellent written, verbal, and presentation skills, and the capacity to work independently and adjust priorities in a fast-paced environment are also essential. Preferred qualifications include a graduate or advanced degree, audit or consulting experience, and experience with metrics, reporting, and communicating with state regulatory agencies.

Responsibilities

The Senior Compliance Professional is responsible for ensuring compliance with governmental requirements and developing and implementing compliance policies and procedures. This role involves researching compliance issues, recommending changes to ensure adherence to contract obligations, and maintaining relationships with government agencies. Responsibilities also include coordinating site visits for regulators, managing the implementation and compliance with corrective action plans, and influencing department strategy. The professional will make decisions on moderately complex to complex technical approaches for project components and perform work without direction, exercising considerable latitude in determining objectives and approaches.

Skills

Healthcare compliance

Cross-functional collaboration

Claims

Privacy

Provider contracting

Kentucky Department for Medicaid Services regulations

Kentucky Department of Insurance regulations

CMS regulations

MS Office Suite

Word

Excel

Regulatory research

Policy development

Procedure implementation

Government agency relations

Audit

Consulting

Metrics and reporting

Written communication

Verbal communication

Presentation skills

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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