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Years of Experience
Date Last Verified
ProfileCompliance Risk Advisor - Medicare Part D The candidate will be 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. Will assess and understand compliance requirements for assigned business/process area(s). Develop business relationship with assigned business/process area and hold business process area accountable for self-reporting of compliance risks. 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 and are appropriately documented. Identify business area compliance metrics, monitor for compliance trends and compliance/FWA risks, and assist in audits against policy and procedure, using data-driven approach. 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. Document compliance/FWA issues/risks in a central database and ensure corrective action plans are created and implemented. Conduct/participate in annual targeted or general enterprise compliance risk assessment activities. Conduct Quarterly Compliance Audits. Coordinate or participate in regulatory audit/exam, survey and other activities. Participate in special projects and report to risk leader and/or risk subcommittee as needed. Seek competitor information on compliance activities and violations for potential use in revisions to Humana’s Compliance Program activities.
Qualification and Experience
The candidate should have Bachelor’s Degree. Must have strong written and verbal communication skills. Advanced research, problem-solving, analytical and negotiation skills is required. Strong PC skills including web enabled technologies such as internet based applications; Microsoft Word, Excel, PowerPoint is required. Must have previous compliance or audit experience. Juris Doctor from accredited law school is desired. Have prior experience and knowledge about Medicare Advantage and risk adjustment is desired. Prior background working in a compliance related area is desired. Knowledge of the healthcare insurance industry is desired. Prior work experience with project management is desired. Experience interacting with governmental agencies is desired.