Compliance Lead

Humana • Carapichaima, IL

3d • $115,200 - $158,400 • Remote

About The Position

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 Michigan 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 fast-growing 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: Serves as dedicated Regulatory Compliance Officer for Michigan Medicaid contract. Build relationships with market leadership teams and external regulators; Provide ongoing oversight of Medicaid operations from readiness review through contract duration to ensure full compliance and minimize risk for the Enterprise; Perform risk assessments, develop and implement annual regulatory compliance auditing and monitoring work plans, oversee corrective action plans and document remediation activities. Interpret and define state and federal regulatory and contract requirements for Humana Departments and/or external business partners and provide ongoing guidance. Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards; Participate in external audits to review document submissions, prepare presenters, and coordinate responses for regulators, as necessary; Work across Humana operational units and product lines to enhance compliance data analytics and operational improvement efforts; Coordinate and manage a standard set of data relating to regulatory standards and report compliance issues to senior leadership and compliance oversight committees. Chair the Michigan Compliance Committee per approved charter; Coordinate compliance related communication/interaction with outside regulators, as necessary. Coordinate with the Special Investigations Unit (SIU) to operate and effective fraud, waste and abuse program integrity program.

Requirements

• Bachelor's degree in related field
• 3+ years of advanced experience working in a Compliance-related or managed care-related field or Medicaid
• 3+ years of interpreting and guiding on regulations and compliance requirements governing the health care industry.
• 3 or more years analyzing and reviewing metrics related to contract compliance
• Demonstrated ability to communicate with clarity, professionalism, and impact across internal and external stakeholder groups, both verbally and in writing.

Nice To Haves

• Juris Doctor and/or advanced degree
• Audit experience
• Experience with metrics and reporting
• Experience working with regulatory agencies, including state departments of health insurance and/or CMS

Responsibilities

• Serves as dedicated Regulatory Compliance Officer for Michigan Medicaid contract.
• Build relationships with market leadership teams and external regulators.
• Provide ongoing oversight of Medicaid operations from readiness review through contract duration to ensure full compliance and minimize risk for the Enterprise.
• Perform risk assessments, develop and implement annual regulatory compliance auditing and monitoring work plans, oversee corrective action plans and document remediation activities.
• Interpret and define state and federal regulatory and contract requirements for Humana Departments and/or external business partners and provide ongoing guidance.
• Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards.
• Participate in external audits to review document submissions, prepare presenters, and coordinate responses for regulators, as necessary.
• Work across Humana operational units and product lines to enhance compliance data analytics and operational improvement efforts.
• Coordinate and manage a standard set of data relating to regulatory standards and report compliance issues to senior leadership and compliance oversight committees.
• Chair the Michigan Compliance Committee per approved charter.
• Coordinate compliance related communication/interaction with outside regulators, as necessary.
• Coordinate with the Special Investigations Unit (SIU) to operate and effective fraud, waste and abuse program integrity program.

Benefits

• 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
• bonus incentive plan

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level