Sr Compliance RCM & Coding Auditor
: Job Details :

Overview

Become a part of our caring community and help us put health first.

CenterWell Senior Primary Care (PCO) is a growing provider organization that currently operates about 340+ senior focused primary care centers in 15 states. The Regulatory Compliance team supports the PCO by assessing, investigating, auditing and mitigating compliance risk across the organization. This team ensures that healthcare providers align their operational practices with legal requirements while fostering collaborative relationships with business partners to uphold ethical standards and mitigate risks.

The Senior Clinical Compliance Professional will support the Director of Compliance by ensuring compliance with governmental requirements for clinics across federal and state requirements. The work involves moderately complex to complex issues where the analysis of situations or data requires in-depth evaluation of variable factors.

As the Senior Clinical Compliance Professional, you will develop and/or evaluate compliance policies and procedures, research compliance issues and recommend changes that assure compliance with federal and/or state requirements related to Provider Clinic operations, billing, investigations, and processes. You will coordinate site visits for regulators, implementation of corrective action plans, and participate in all phases of the audit process including evaluating control design and adequacy, testing adherence to policies and internal controls, and communicating issues and recommendations to management. You will understand department, segment, and organizational strategy and operating objectives and their linkages to related areas.

You will serve as a regulatory compliance subject matter expert with the 2nd line of defense compliance function, researching compliance related issues and communicating requirements to high level business leaders within the PCO.

Key Responsibilities

• Assesses the compliance risks to PCO and uses the assessment to design auditing and monitoring activities in the workplan.
• Executes assigned portions of the PCO compliance workplan throughout the year.
• Regularly conducts compliance related audits to assess internal controls, examine healthcare records and processes, and analyze and report risks.
• Influences department strategy by identifying and overseeing the development of continuous monitoring activities.
• Provides reporting on metrics and M&A activity related to revenue cycle management.

Use your skills to make an impact Required Qualifications

• Bachelor's degree
• 3 or more years of healthcare experience in revenue cycle management (billing, coding, collections for Medicare and Medicaid claims)
• Experience with auditing and monitoring of healthcare records
• Must be able to work core business hours on EST time between 9am-5pm
• Willingness to travel up to 10% to conduct audits at site locations
• Ability to manage multiple or competing priorities and meet deadlines
• Passion for contributing to an organization focused on continuously improving consumer experiences
• Effective verbal and written communication skills
• Strong attention to detail
• Ability to articulate findings and impacts
• Knowledge/understanding of laws and regulations governed by the Department of Insurance and CMS

Preferred Qualifications

• Compliance regulations knowledge and compliance auditing experience
• Ability to analyze large data sets
• Knowledge of healthcare compliance, mainly primary care and risk adjustment; pharmacy knowledge is a plus
• Certified Coder (CPC, CRC, and/or CMC)
• Experience with metrics and reporting

Additional Information Work-At-Home Requirements

• To ensure Home or Hybrid Home/Office associates ability to work effectively, the self-provided internet service must meet criteria: download speed of 25 Mbps and upload speed of 10 Mbps; wireless, wired cable or DSL connection recommended.
• Satellite, cellular and microwave connections can be used only if approved by leadership.
• Associates who live and work from Home in California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for internet expense.
• Humana provides Home or Hybrid Home/Office associates with telephone equipment appropriate to meet business requirements.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

We will use HireVue for part of our hiring process. If selected for a first-round interview, you will receive an email with an invitation to participate in a HireVue interview, which will involve answering questions via phone or text responses. The interview is expected to take about 15-20 minutes. Your recorded interview will be reviewed to determine next steps.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

$86,300 - $118,700 per year

This job is eligible for a bonus incentive plan based on company and/or individual performance.

Description of Benefits

Humana offers competitive benefits to support whole-person well-being, including medical, dental and vision; 401(k); time off; disability and life insurance; and other opportunities.

Application Deadline: 09-25-2025

About us

Humana Inc. (NYSE: HUM) is committed to putting health first. Through Humana insurance services and CenterWell healthcare services, we help millions achieve their best health.

Equal Opportunity Employer

Humana does not discriminate on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or protected veteran status. We comply with applicable laws and provide free language interpreter services. See accessibility resources:

#J-18808-Ljbffr