Remote Compliance Specialist, Payment Integrity (Medicare/Medicaid)

Humana, Inc.; Salem (OR); À distance; USD 65 000 - 89 000; Plein temps

Résumé du poste

Humana, Inc. is seeking a Compliance Professional 2 to support Medicare and Medicaid compliance activities, focusing on Payment Integrity financial recovery processes. The role emphasizes proactive monitoring, reporting, and cross-functional collaboration to ensure regulatory adherence.

It requires attention to detail, timely execution, and familiarity with Medicare/Medicaid requirements. This remote position supports Humana’s Payment Integrity framework, with occasional travel and a US-wide

Qualifications

• 2+ years of experience in compliance or with Medicare/Medicaid federal regulations
• Payment Integrity experience
• Experience managing project-based work
• Intermediate proficiency in Microsoft Word and Excel
• Strong analytical, organizational, and communication skills
• Must be located within the contiguous United States based on Medicare and Medicaid requirements

Responsabilités

• Support Medicare and Medicaid compliance activities related to Payment Integrity, with a primary focus on financial recovery processes.
• Monitor operations to ensure compliance with regulatory, contractual, and internal requirements.
• Identify potential or actual noncompliance and coordinate timely mitigation and follow-up actions.
• Perform compliance reviews, monitoring, and reporting for accuracy and timeliness.
• Serve as a liaison between Compliance and CAPI business partners to support effective communication and issue resolution.
• Analyze data, trends, and outcomes to identify gaps and improvement opportunities.
• Support corrective action planning and remediation with cross-functional teams.
• Maintain documentation and audit-ready materials related to compliance monitoring.
• Assist in developing and executing the Payment Integrity Compliance framework.
• Identify automation opportunities to strengthen oversight and efficiency.
• Manage assigned projects and deliverables with timely, accurate work.
• Provide team support to maintain continuity of compliance monitoring and financial recovery operations

Connaissances

Compliance experience

Payment Integrity

Project management

MS Excel

MS Word

Analytical skills

Communication skills

Description du poste

Humana, Inc. is seeking a Compliance Professional 2 to support Medicare and Medicaid compliance activities, focusing on Payment Integrity financial recovery processes. The role emphasizes proactive monitoring, reporting, and cross-functional collaboration to ensure regulatory adherence.

It requires attention to detail, timely execution, and familiarity with Medicare/Medicaid requirements. This remote position supports Humana’s Payment Integrity framework, with occasional travel and a US-wide