CCM Compliance Professional 2 - Work at home EST or CST

Profile

Description

The Compliance Professional 2 ensures the successful implementation of Medicaid contracts for the CCM division. This is done by attending and facilitating regular project implementation meetings, tracking policy and procedures and ensuring they are implemented by various business units under CCM to ensure compliance. This role may also, when needed, assist with various audit responses and presentations as required. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

Responsibilities

Responsibilities including but not limited to:

Regular communication and presentation coordination needs to CCM Business SME/Medicaid Implementation Advisors, CMU or Auditors.

Design and create standard reporting and metrics for CCM Compliance Team related activities.

Oversee the development of compliance related policies and documentation.

Identify and leverage best practices in compliance

Develop and maintain key relationships with business areas

Partner with CCM SMEs to successfully identify risks of new business and facility meetings to track implementation process.

Additional needs as assigned by the CCM Senior Compliance Professional

Required Qualifications

Strong Compliance, Government Agency and/or Paralegal Background

Strong attention to detail, organizational skills and meeting facilitation skills

Experience managing projects that includes maintaining timelines, documentation and communication

Ability to maintain efficient records and documentation system

Proven ability building relationships with cross-functional teams with areas Claims Cost Management and Compliance.

Proficient in computer software such as: SharePoint, MS Office Skills, specifically PowerPoint and Excel

Proven ability to listen and identify root cause or scope of project/issue

Work at Home/Remote Requirements

Must ensure designated work area is free from distractions during work hours and virtual meetings

Must provide a high-speed DSL or cable modem for a workspace (Satellite, wireless and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

Bachelor's degree

Strong research skills - ability to identify if contractual language impacts CCM (Claims Cost Management) business

Ability to review legislation/contracts and interpret into a laymen's perspective

CCM business knowledge (expert level desired)

Previous experience handling government agency audits

OnSpring database development

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com