Director of Risk Adjustment Regulatory Audits

Humana

11d•$150,000 - $206,300•Remote

About The Position

The Director of Risk Adjustment Regulatory Audits develops strategy and leads execution of Humana’s external risk adjustment regulatory audits to support successful audit outcomes and minimize financial impacts. The role oversees operational processes for audit intake, communication with regulatory bodies, record submission, performance analysis, reporting, and tracking. It also identifies opportunities to improve audit workflows through technology and process enhancements, and uses audit analytics and results to inform future strategy. The Director builds cross-functional relationships and partnerships across Humana, including with Quality Cost & Strategy, market risk adjustment associates, legal, and regulatory compliance partners. The role sets team goals and priorities, manages staffing and budgets, evaluates organizational resources, and drives a positive culture that embodies the Humana Way. This position reports to the Associate VP, Risk Adjustment Compliance. This is a remote, full-time position with 40 scheduled hours per week. Occasional travel to Humana offices for training or meetings may be required. Home-based employees must have internet service with at least 25 Mbps download and 10 Mbps upload speeds and work from a dedicated space that protects member PHI/HIPAA information. The role is not eligible for work visa sponsorship.

Requirements

5 or more years of project and people leadership experience.
8–10 or more years of experience in strategic operations and analytics, including process improvement and stakeholder influence.
5 or more years of experience in program development and management, using metrics and performance reporting to track results.
5 or more years of process improvement and operations experience.
Strong influencing and collaboration skills.
Excellent oral and written communication skills.

Nice To Haves

Experience communicating with external regulators.
Experience presenting to senior leadership.

Responsibilities

Develop strategy and execute external risk adjustment regulatory audits to achieve successful outcomes and minimize financial impacts to Humana.
Ensure operational processes are followed for regulatory audit intake, communication with regulatory bodies, and submission of records.
Develop and maintain reporting and tracking for all risk adjustment regulatory audits.
Determine strategic approaches for responding to regulatory audits.
Analyze audit performance and identify opportunities to improve external regulatory audits.
Collaborate with Quality Cost & Strategy partners, market risk adjustment associates, and other Humana associates, including legal and regulatory compliance partners.
Drive the development and execution of analytics on audit data and results to inform future strategy and minimize risk related to risk adjustment data.
Implement technology-based solutions to improve the efficiency and accuracy of audit workflows and processes.
Manage communications with regulatory bodies throughout the audit process.
Establish and manage team goals, priorities, staffing, and budgets.
Evaluate organizational resources and determine future enhancements to support the work.
Drive a positive culture that embodies the Humana Way.