Become a part of our caring community and help us put health firstThe Compliance (UM) Analyst/ Professional 2 conducts and summarizes compliance audits.The Compliance (UM) Analyst / Professional 2 collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals.
Reviews and interprets new CMS and regulatory requirements and works with the business area to ensure compliance with requirements.
Manages tasks and timelines to ensure compliance with regulatory initiatives.
Conducts quality assurance audits of pre-service organization determinations to ensure compliance requirements and internal processes are being followed.
Generation and data scrubbing of CMS audit universes including source system validations.
Reviews and validates monthly compliance metrics and works with the business area to identify root cause and implement corrective action plan for any non-compliant metrics.
Works with the business area in updating policies and procedures.
Attends assigned compliance meetings and acts as the liaison between the HSO compliance team and Health Services business areas.
Coordinate special compliance projects and any additional tasks as determined by leadership.
Use your skills to make an impactRequired Qualifications
1 or more years of work experience in a compliance, auditing, and/or in a health plan working in the utilization management department.
1 or more years of managing departmental updates, process improvement and/or special projects.
1 or more years of experience with trending and analyzing data.
Comprehensive knowledge of Microsoft Outlook, Word and Excel
Hours: Monday-Friday 8:00 AM-5:00 PM Eastern Time, occasional overtime as needed.
Preferred Qualifications
Bachelor's Degree
Strong analytical and attention to detail skills.
Certification(s) relevant to compliance area of expertise, such as certification in healthcare compliance (CHC)
Prior Medicare health plan experience
Knowledge of CMS regulations pertaining to compliance in a managed care health plan
Bilingual (English and Spanish)
Additional Information
Hours: Monday-Friday 8:00 AM-5:00 PM Eastern Time, occasional overtime as needed.
Available to travel to Miami, Florida based on business needs
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.Work at Home GuidanceTo ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
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
Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.#LI-BB1Scheduled Weekly Hours40Pay RangeThe 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.$63,400 - $87,400 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, 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.About usAbout CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our 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, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity EmployerIt 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.Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.