at Humana in Springfield, Illinois, United States
Job Description
Become a part of our caring community and help us put health first
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.
The CCM Compliance Professional 2 (CP2) supports our Medicaid contracts and Medicare regulations. This includes coordinating agency provider alerts related to fraud, waste and abuse (FWA) and 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. Develops and implements compliance policies and procedures. Research compliance issues and recommends changes that assure compliance with contract obligations. Completes FWA compliance reporting. Supports Seniors on the team for Medicaid implementations, contract amendments and audits pertaining to FWA. 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.
Use your skills to make an impact
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 25×10 (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
Pay Range
The 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.$57,700 – $79,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, 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 us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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 Employer
It 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 because he or she is a protected veteran. 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=Humana_Website.
