Humana Medicare Part D Compliance Risk Advisor in Louisville, Kentucky

Role: Compliance Risk Advisor Assignment: Medicare Compliance Location: Louisville KY or Work at Home

Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.

Assignment Capsule

Humana is seeking a Compliance Risk Advisor for the Medicare Pharmacy Regulatory Compliance team. The role includes providing guidance and helping to enhance and oversee the compliance program related to Medicare Part D and to minimize compliance risk exposure to the company.

* Assess and understand compliance requirements for assigned business/process area(s).

  • Review new and revised compliance requirements to identify impacts to assigned business/process area(s).

  • Provide guidance and direction to business area(s) and assist in review/revision of new and existing processes and policy to ensure compliance controls exist as well as having them appropriately documented.

  • Identify compliance metrics, monitor for compliance trends and compliance risks, and assist in audits against policy and procedure, using data-driven approach for aligned business area. Risk Identification and Corrective Action Plan Monitoring

  • Investigate and document internally- or externally-identified alleged regulatory compliance infractions related to assigned business area(s).

  • Report identified issues/risks to designated risk leader and risk subcommittee.

  • Provide guidance and direction on creation of corrective actions, oversight, monitoring and/or auditing of implementation of the resolution or mitigation of the compliance or FWA issue/risk.

  • Conduct routine Compliance Audits. Regulatory Audits/Exams

  • Coordinate or participate in regulatory audit/exam, survey and other activities.

  • Maintain detailed knowledge of audit protocols & requirements and regulatory requirements impacting audits.

  • Conduct pre-audit risk assessment.

  • Track, monitor and review for compliance corrective action plans and remediation activities. Risk Management

  • Develops systems to identify and analyze potential sources of risk in order to minimize controllable business, liability, and/or compliance risks to the organization; handles events or trends that do occur to minimize their effect, cost and compliance liability.

    Problem Solving

  • Proactively identifies, evaluates, and solves problems with rigorous logic and a systematic approach; looks beyond the obvious to see root cause issues and creative solutions. Key Competencies

  • Accountability: Meets established expectations and takes responsibility for achieving results; encourages others to do the same.

  • Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.

  • Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.

  • Interpersonal Effectiveness : Understands oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships.

    Role Essentials

  • Bachelor’s Degree

  • Strong written and verbal communication skills

  • Advanced research, problem-solving, analytical and negotiation skills

  • Strong critical-thinking skills

  • Possess the capacity to maintain confidentiality and work independently

  • Are self-motivated and possess the ability to manage multiple priorities and work under pressure to meet deadlines

  • Comprehensive knowledge of MS office products.

  • Ability to quickly develop strong professional working relationships internally and externally Role Desirables

  • Have prior experience with and knowledge about Medicare Part D and/or Medicare Advantage

  • Have prior background working in a compliance-related area

  • Knowledge of the healthcare insurance industry

  • Previous compliance or audit experience

  • Experience interacting with governmental agencies

  • Juris Doctor from accredited law school Additional Information

    At Humana, we are also committed to making the resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. We know your well-being is important to you, and it is important to us too. If you share our passion for helping people, we likely have the right place for you at Humana.

Title: Medicare Part D Compliance Risk Advisor

Location: TN-Columbia

Other Locations: US-KY-Louisville

Requisition ID: 188159

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.