CenterWell PCO, Sr Compliance Professional

Humana Inc; Montana; Remote; USD 86,000 - 119,000; Full time

Job summary

Join a forward-thinking organization dedicated to improving health outcomes as a Senior Compliance Professional. In this role, you will ensure compliance with federal and state regulations across numerous clinics, evaluate policies, and conduct audits to mitigate risks. You will collaborate with high-level business leaders and contribute to the strategic direction of the compliance function. This is an exciting opportunity to make a significant impact in a dynamic healthcare environment focused on enhancing consumer experiences. If you are passionate about compliance and healthcare, this role is for you!

Benefits

Medical benefits

Dental benefits

Vision benefits

401(k) retirement plan

Paid time off

Short-term disability

Long-term disability

Life insurance

Qualifications

• 2+ years in healthcare related field with compliance auditing experience.
• Knowledge of laws and regulations governed by the DOJ and CMS.

Responsibilities

• Develop and evaluate compliance policies and procedures.
• Conduct compliance audits and assess internal controls.
• Coordinate implementation of corrective action plans.

Skills

Compliance regulations knowledge

Auditing experience

Effective verbal communication

Attention to detail

Ability to manage multiple priorities

Research skills

Education

Bachelor's degree

Tools

Data analysis tools

Job description

Become a part of our caring community and help us put health first

CenterWell Senior Primary Care (PCO) is a growing provider organization that currently operates about 340+ senior focused primary care centers in 15 states. The Regulatory Compliance team that supports the PCO is responsibility to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This team ensures that healthcare providers align their operational practices with legal requirements while fostering collaborative relationships with business partners to uphold ethical standards and mitigate risks.

The Senior Compliance Professional will support the Director of Compliance, by ensuring compliance with governmental requirements for clinics across both federal and state 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.

As the Senior Compliance Professional, you will develop and/or evaluate compliance policies and procedures. Research compliance issues and recommends changes that assure compliance with federal and/or state requirements related to Provider Clinic operations, billing, investigations, and processes. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. You will participate in all phases of the audit process including evaluating control design and adequacy, testing to ensure adherence with established policies and internal controls, and communicating issues and recommendations to management. Coordinates implementation and compliance with corrective action plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

In this role, you will serve 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. 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.

Key Responsibilities:

• 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 audits to assess internal controls, examining healthcare records and processes, and analyzing and reporting risks.
• Influences department strategy by identifying and overseeing the development of continuous monitoring activities.
• Provides reporting on metrics and M&A activity.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree.
• 2 or more years in healthcare related field.
• Compliance regulations knowledge and compliance auditing experience.
• Knowledge/understanding of laws and regulations governed by the DOJ and CMS.
• Must be able to work core business hours on EST time between (9am-4pm).
• Ability to travel up to 15% to conduct audits at site locations.
• Effective verbal and written communication skills.
• Strong attention to detail.
• Ability to articulate findings and impacts.
• Familiarity with healthcare provider compliance, mainly primary care, hospital, and/or pharmacy.
• Ability to manage multiple or competing priorities and meet deadlines.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Preferred Qualifications

• CHC certification or similar.
• Medicare Risk Adjustment Experience.
• Clinical background preferred, with Part B and Specialist experience a plus.
• Ability to analyze large data sets.
• Experience or knowledge of Accountable Care Organizations (ACO) preferred.
• Six Sigma or Lean Certified.
• Graduate degree, MBA or Healthcare focus a plus.
• Experience with metrics and reporting.

Additional Information

Work-At-Home Requirements:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format:

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

If you are selected for a first-round interview, you will receive an email correspondence inviting you to participate in a HireVue interview. In this interview, you will receive a set of interview questions over your phone, and you will provide recorded or text message responses to each question. You should anticipate this interview to take about 15-20 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay 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. $86,300 - $118,700 per year. This 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 04-20-2025

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.