CCM Compliance Professional 2

Profile

Description

The CCM Compliance Professional 2 ensures compliance with governmental and contractual requirements. The CCM Compliance Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The CCM Compliance Professional 2 (CP2) coordinates agency provider alerts related to fraud, waste and abuse (FWA) ensuring delivery to all impacted business areas. These alerts relate to claims payments and provider contracting. The CCM CP2 also Coordinates FWA requests for information from various government agencies and responds timely with all information requested. Majority of work supports our state Medicaid agency contracts. Develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures and develops new guidelines/procedures as necessary.

Required Qualifications


2 years experience with compliance or Medicaid state regulations or experience working with government agencies or paralegal or legal work experience
Intermediate Word and Excel skills
Proven experience with multitasking and meeting tight deadlines
Strong attention to detail


Preferred Qualifications


Healthcare industry experience
Claims/Encounters experience
Claims Cost Management experience
Associate's or Bachelor's Degree


What Humana Offers

Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

How we Value You


Benefits starting day 1 of employment
Competitive 401k match
Generous Paid Time Off accrual
Tuition Reimbursement
Parent Leave
*Go365 perks for well-being


Additional Information

Remote/Work at Home Requirements


Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information


Scheduled Weekly Hours

40

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 ****

Company info

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