Compliance Manager - Auditing/Coding

Profile

Description

The Compliance Manager ensures compliance with governmental requirements. The Compliance Manager works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Compliance Manager develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. Ensure audit conclusions are based on a complete understanding of the process, circumstances, and risk and are well documented. Builds, develops and maintains strong business relationships with colleagues on the team, within the business line and with technology partners.

Required Qualifications

Bachelor's Degree

2 or more years of project leadership experience

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Advanced experience with building, collecting, validating, and communicating large sets of data

3-5 years experience in an audit role

Intermediate experience with medical , HCPIS/CPT and/or diagnosis coding

Preferred Qualifications

Advanced graduate degree

Coding certification; CPC, CRC

Project Management Professional (PMP) certification

Six Sigma certification

Leadership experience

8 or more years of compliance or related experience

Additional Information

Scheduled Weekly Hours

40

Company info

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