The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and complexity ranging from moderate to substantial.
The Compliance Lead serves as the dedicated Compliance Officer for Kentucky to analyze business requirements, provide research and regulatory interpretation, and advise internal business units and external business partners in delivering results in a manner that minimizes compliance risk exposure for the Company. As a Compliance Lead for our Medicaid business, you will be part of a team who develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners and oversight agencies. While working within assigned areas to optimize business results, you will:
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Serves as dedicated Regulatory Compliance Officer for Kentucky Medicaid contract.
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Build relationships with market leadership teams and external regulators;
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Provide ongoing oversight of Medicaid operations from readiness review through contract duration to ensure full compliance and minimize risk for the Enterprise;
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Perform risk assessments, develop and implement annual regulatory compliance auditing and monitoring work plans, oversee corrective action plans and document remediation activities.
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Interpret and define state and federal regulatory and contract requirements for Humana Departments and/or external business partners and provide ongoing guidance.
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Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards;
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Participate in and manage external audits to review document submissions, prepare presenters, and coordinate responses for regulators, as necessary;
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Work across Humana operational units and product lines to enhance compliance data analytics and operational improvement efforts;
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Coordinate and manage a standard set of data relating to regulatory standards and report compliance issues to senior leadership and compliance oversight committees.
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Chair the Kentucky Compliance Committee per approved charter;
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Coordinate compliance related communication/interaction with outside regulators, as necessary.
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Coordinate with the Special Investigations Unit (SIU) to operate and effective fraud, waste and abuse program integrity program.
What makes you successful:
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Demonstrated ability to communicate with clarity, professionalism, and impact across internal and external stakeholder groups, both verbally and in writing.
Required Qualifications
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Bachelor's degree in related field
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7+ years of advanced experience working in a compliance-related or managed care-related field or Medicaid
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3+ years of interpreting and guiding on regulations and compliance requirements governing the health care industry.
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3 or more years analyzing and reviewing metrics related to contract compliance
Preferred Qualifications
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Juris Doctor and/or advanced degree
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Audit experience
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Experience with metrics and reporting
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Experience working with regulatory agencies, including state departments of health insurance and/or CMS
Additional Information
This role is only open to Kentucky applicants.
You must be available to meet with regulators at a location in the Commonwealth they specify with twenty-four (24) hours’ notice.
In this role you will report to the Associate Director of Compliance.
This role is an individual contributor.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$115,200 - $158,400 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
