We have other current jobs related to this field that you can find below

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    4 days ago

    Charleston, West Virginia, United States ERM Consulting & Engineering, Inc. Full time

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  • Managing Consultant, Environmental Permitting

    3 weeks ago

    Charleston, United States ERM Consulting & Engineering, Inc. Full time

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  • Culinary Specialist for Senior Living

    5 days ago

    Charleston, West Virginia, United States Brookdale Senior Living Full time

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  • State Compliance Coordinator

    1 month ago

    Charleston, United States The PEOPLEASE Group Full time

    POSITION SUMMARY The PEOPL EASE Group is a leading Professional Employer Organization (PEO) serving 70,000 employees. Our industry focus and strategic growth plan have positioned us to be the leading provider of PEO services in the United States serving the blue and gray collar markets. The PEOPL EASE Group is looking for a qualified State Compliance...

  • State Compliance Coordinator

    1 month ago

    Charleston, United States PEOPLEASE Full time

    POSITION SUMMARY The PEOPLEASE Group is a leading Professional Employer Organization (PEO) serving 70,000 employees. Our industry focus and strategic growth plan have positioned us to be the leading provider of PEO services in the United States serving the blue and gray collar markets. The PEOPLEASE Group is looking for a qualified State Compliance...

  • Managing Consultant, Environmental Permitting

    2 months ago

    Charleston, United States The ERM International Group Limited Full time

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  • Assistant Athletic Director for Compliance

    1 month ago

    Charleston, West Virginia, United States Eastern Illinois University Full time

    Eastern Illinois University is seeking candidates for the position of Assistant Athletic Director for Compliance. This position reports to the Director of Athletics and serves as a member of the Athletic Senior Leadership Staff. This position provides leadership to the compliance unit relative to education, monitoring, enforcement and maintenance of a...

  • Senior Analyst, Advanced Analytics

    4 weeks ago

    Charleston, United States Integral Senior Living Full time

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  • Senior Quality and Compliance Specialist

    2 months ago

    Charleston, United States MMS Full time

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  • Cook-Senior Living

    3 months ago

    Charleston, United States Brookdale Senior Living Full time

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  • Compliance Coordinator

    2 weeks ago

    Charleston, United States K12 Services, Inc. Full time

    Job Description Certificates and Licenses: West Virginia Special Education Teacher Certification Residency Requirement:Must be an West Virginia Resident Thispositionisahybridpositionwithsomein the Charleston, WVofficetimerequired. K12, a Stride Company, believes in Education for ANY ONE. We provide families an online option for a high-quality,...

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    2 weeks ago

    Charleston, United States Baker Tilly Advisory Group, LP. Full time

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  • Senior Living Activities Director

    2 weeks ago

    Charleston, United States English Meadows Senior Living Communities Full time

    English Meadows Senior Living is a locally owned company providing excellent care to our wonderful Residents. We are passionate about assisted living and ensure each of our Caregivers looks forward to the day just as much as our Residents in our communities. We are looking for a compassionate, enthusiastic Activity Director to carry out the Activity...

  • Senior Tax Consultant

    5 days ago

    Charleston, West Virginia, United States Lincoln Search Consultants Inc Full time

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  • Housekeeper- Assisted Living

    2 months ago

    Charleston, United States TerraBella Senior Living Full time

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  • Senior Living Activities Director

    1 month ago

    Charleston, United States English Meadows Senior Living Communities Full time

    English Meadows Senior Living is a locally owned company providing excellent care to our wonderful Residents. We are passionate about assisted living and ensure each of our Caregivers looks forward to the day just as much as our Residents in our communities. We are looking for a compassionate, enthusiastic Activity Director to carry out the Activity program....

  • Sustainability Compliance Engineer

    5 days ago

    Charleston, West Virginia, United States Manpower Group Inc. Full time

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  • Regulatory Compliance Specialist

    5 days ago

    Charleston, West Virginia, United States United Talent Staffing Full time

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  • PAR - Compliance Analyst II

    2 months ago

    Charleston, United States Medical Mutual Full time

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  • Senior System/ Electrical Engineer

    4 weeks ago

    Charleston, United States KBR Full time

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Senior Compliance Professional

2 months ago

Charleston, United States Humana Full time

Humana Senior Compliance Professional - Charleston, West Virginia

Become a part of our caring community and help us put health first The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Compliance Professional's primary focus will be to develop and implement a plan to monitor and audit business processes to prevent, detect, and resolve compliance issues to help ensure an effective compliance program for Claims, COB (Coordination of Benefits), Subrogation, and Provider Payment Integrity for the Medicare line of business. The Senior Compliance Professional develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Key responsibilities may include: Research, understand and apply laws, regulations, and regulatory guidance for Claims, COB (Coordination of Benefits), Subrogation, Provider Payment. Serve as the subject matter expert on Claims, COB (Coordination of Benefits), Subrogation, Provider Payment Integrity. Develop audit methodology and perform auditing and monitoring activity to prevent and detect issues of noncompliance and provide guidance on remedial actions to strengthen compliance controls and ensure compliance with state and federal laws and regulations. Analyze business requirements and complex issues, conduct research, and provide regulatory guidance to business partners, Law, and Enterprise Compliance associates and leaders with regard to Claims, COB (Coordination of Benefits), Subrogation, Provider Payment Integrity. Develop and track compliance metrics to help monitor and detect potential compliance issues. Partner with Enterprise Compliance team members on regulatory outreach. Serve as the Regulatory Compliance subject matter expert during CMS program audits. Lead onsite program audit preparation and activity and perform oversight of business audit preparation to ensure timely, accurate and complete submission of required data and documentation to regulators. Present findings of monitoring and auditing efforts to business partners and Enterprise Compliance leaders and track issue to ensure appropriate and timely remediation. Lead and participate on committees, providing compliance guidance and direction. Provide back-up and support to other Enterprise Compliance team members and perform other duties, as needed. Use your skills to make an impact Required Qualifications 5 or more years of technical experience Knowledge/understanding of laws and regulations governed by the Department of Insurance and CMS Preferred Qualifications Graduate or advanced degree Audit or consulting experience Experience with metrics and reporting

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