Compliance Professional
成为我们关心社区的一部分 Humana Healthy Horizons 正在寻找一个合规专业人员 （医疗补助国家报告）来确保遵守与医疗补救州报道有关的政府要求。合规专家的工作任务涉及适度复杂到复杂的问题，其中情况或数据的分析需要对可变因素进行深入评估。合规职业人员将负责协调和提交 Medicaid 国家报道团队所需的国家报告。报告到合规管理者，你将与市场领导层，企业主人和其他利益相关方合作支持准确及及时的状态报告。责任可能包括教育企业主和市场伙伴关于国家报告流程，协调收集和验证所需数据，并确定以及增加数据可用性缺口，可能会影响报告要求。关键责任 o 根据既定要求和时间表协调，编制，审查和提交必要的医疗补助州报道。合作伙伴与企业主，市场合作伙伴和其他利益相关者获取国家报告所需的信息和数据。教育并支持企业主和市场合作伙伴有关国家报告流程，要求和期望。o 在提交之前审查和验证报告数据以确保完整性和准确性。o 确定和加剧可能影响及时和精确的报告的数据缺陷，报告问题或过程担忧。o 支持实施新的和修改的国家报告要求和指导方针。o 维护报告文档和支持进程改善以促进一致性，准确性和效率。需要的资格 o 必须居住在美国东部或中央时区内，或者拥有医疗保健行业，保险服务和/或监管服务的学历超过5年。o3年以上合规或项目/流程管理经验 o 包括 Word,Excel 和 PowerPoint 优先资格的所有微软办公应用程序的全面实操了解 o 医疗补助国家报告经验 o 医疗补救机构经验/知识 o 以前对数据和指标进行分析以影响部门流程变化 o 之前的医疗保险行业经验 o 使用微软的经验
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Become a part of our caring community
Humana Healthy Horizons is seeking a Compliance Professional (Medicaid State Reporting) who will ensure compliance with governmental requirements as they relate to Medicaid State reporting. The Compliance Professional’s work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.The Compliance Professional will be responsible for coordinating and submitting required state reports for the Medicaid State Reporting team. Reporting to the Compliance Manager, you will partner with market leadership, business owners, and other stakeholders to support accurate and timely state reporting. Responsibilities may include educating business owners and market partners on state reporting processes, coordinating the collection and validation of required data, and identifying and escalating gaps in data availability that may impact reporting requirements.
Key Responsibilities
o Coordinate, prepare, review, and submit required Medicaid state reports in accordance with established requirements and timelines.
o Partner with business owners, market partners, and other stakeholders to obtain information and data needed for state reporting.
o Educate and support business owners and market partners on state reporting processes, requirements, and expectations.
o Review and validate reporting data for completeness and accuracy prior to submission.
o Identify and escalate data gaps, reporting issues, or process concerns that may impact timely and accurate reporting.
o Support the implementation of new and amended state reporting requirements and guidance.
o Maintain reporting documentation and support process improvements to promote consistency, accuracy, and efficiency.
Use your skills to make an impact
Required Qualifications
o Must reside in the eastern or central time zones within the contiguous United States
o Bachelor's degree or 5+ years of healthcare industry, insurance services and/or regulated services.
o 3 plus years compliance or project/process management experience
o Comprehensive working knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
Preferred Qualifications
o Medicaid state reporting experience
o Medicaid experience/knowledge
o Prior experience analyzing data and metrics to influence change in departmental processes
o Prior health insurance industry experience
o Experience using Microsoft Copilot
Additional Information
o Location: Remote US - Must reside in the eastern or central time zones within the contiguous United States
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$65,000 - $88,600 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 10-26-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Originally posted on Himalayas