Job is Expired
Location: Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Wisconsin
Compensation: To Be Discussed
Staff Reviewed: Fri, Mar 03, 2023
Job Summary
A health insurance company is seeking a Remote Senior Medical Compliance Professional.
Must be able to:
- Perform mock audits of Humana's Claim Cost Management Organization
- Plan, execute and report mock audits and the associate deficiencies found as a result of the audits
- Conduct mock audits on processes identified and make decisions on the best methodology to conduct the audits
Required Skills:
- 2 years of experience conducting mock audits, responding to compliance audits or experience monitoring compliance activities
- 2 years of experience interpreting data and policy/procedures
- 2 years of experience interpreting contract language and legislation
- Knowledge/understanding of laws and regulations governed by the Department of Insurances, Medicaid and CMS
- Strong written communication and organizational skills
- Ability to collaborate with multiple business units
