CenterWell PCO, Sr Compliance Professional

Humana; United States; Remote; USD 86,000 - 119,000; Full time

Job summary

Join a forward-thinking organization dedicated to health and well-being as a Senior Compliance Professional. In this pivotal role, you will ensure adherence to federal and state regulations across clinics, developing and evaluating compliance policies while collaborating with high-level business leaders. Your expertise will help mitigate compliance risks and improve operational practices, making a meaningful impact on the healthcare landscape. This position offers a dynamic work environment where your contributions will be valued, and your passion for enhancing consumer experiences will shine.

Qualifications

• 2+ years of experience in a healthcare-related field focusing on compliance.
• Knowledge of laws governed by DOJ and CMS is essential.

Responsibilities

• Assess compliance risks and design auditing activities accordingly.
• Conduct regular compliance audits and analyze healthcare records.

Skills

Compliance Regulations Knowledge

Auditing Experience

Effective Communication Skills

Attention to Detail

Data Analysis

Education

Bachelor's Degree

Graduate Degree (MBA or Healthcare Focus)

Job description

CenterWell PCO, Sr Compliance Professional

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

CenterWell Senior Primary Care (PCO) is a growing provider organization operating over 340 senior-focused primary care centers across 15 states. The Regulatory Compliance team supports the PCO by assessing, investigating, auditing, and validating the mitigation of compliance risks across the organization. This team ensures 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 adherence to governmental requirements for clinics across federal and state regulations. The work involves analyzing moderately complex to complex issues, requiring in-depth evaluation of variable factors.

As the Senior Compliance Professional, you will develop and evaluate compliance policies and procedures, research compliance issues, and recommend changes to ensure compliance with federal and state requirements related to provider clinic operations, billing, investigations, and processes. You will coordinate site visits for regulators, implement and monitor corrective action plans, and participate in all audit phases, including evaluating control design, testing adherence, and communicating findings to management. You will also serve as a regulatory compliance subject matter expert, communicating requirements to high-level business leaders and developing risk analysis reports for clinic compliance metrics and M&A activities.

Key Responsibilities:

1. Assess compliance risks and design auditing and monitoring activities accordingly.
2. Execute assigned parts of the compliance workplan annually.
3. Conduct regular compliance audits, examine healthcare records and processes, and analyze/report risks.
4. Influence departmental strategy by developing continuous monitoring activities.
5. Provide reporting on metrics and M&A activity.

Use your skills to make an impact

Required Qualifications:

• Bachelor's degree.
• 2+ years in healthcare-related field.
• Knowledge of compliance regulations and auditing experience.
• Understanding of laws governed by DOJ and CMS.
• Availability to work core hours on EST (9am-4pm).
• Ability to travel up to 15% for audits.
• Effective communication skills.
• Strong attention to detail and ability to articulate findings.
• Familiarity with healthcare provider compliance, especially primary care, hospital, or pharmacy.
• Ability to manage multiple priorities and meet deadlines.
• Passion for improving consumer experiences.

Preferred Qualifications:

• CHC certification or similar.
• Medicare Risk Adjustment experience.
• Clinical background, especially Part B and Specialist experience.
• Ability to analyze large data sets.
• Experience with ACOs.
• Six Sigma or Lean certification.
• Graduate degree (MBA or Healthcare focus).
• Experience with metrics and reporting.

Additional Information

Work-At-Home Requirements: Internet speeds of at least 25 Mbps download and 10 Mbps upload are recommended. Satellite, cellular, or microwave connections require approval. Home-based California, Illinois, Montana, or South Dakota employees will receive internet expense reimbursement. A dedicated workspace free of ongoing interruptions is required.

Interview Process: We use HireVue for initial interviews, which involves recorded responses to questions. Expect the process to take about 15-20 minutes. Occasional travel to Humana offices may be required.

Scheduled Weekly Hours: 40

Pay Range: $86,300 - $118,700 annually, commensurate with experience and location. The position is eligible for a performance-based bonus.

About us

Humana Inc. is committed to putting health first, offering insurance and healthcare services that support whole-person well-being. We aim to improve the quality of life for people with Medicare, Medicaid, families, individuals, military personnel, and communities.

Equal Opportunity Employer

Humana does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. We promote affirmative action and employment based on valid job requirements.

About the company

Humana considers every aspect of your life and works with you to create a personalized path to health.