Medicaid Compliance Officer - State of Indiana

Humana

261d • $115,200 - $158,400 • Remote

About The Position

Be a part of our caring community and help us put health first. Humana's Regulatory Compliance team is dedicated to ensuring that the organization adheres to all applicable laws, regulations, and contractual obligations governing its healthcare operations. This team plays a vital role in identifying, preventing, and addressing compliance issues by conducting thorough analyses of regulatory requirements and business practices. They work collaboratively with various internal departments and external partners to interpret regulations, assess risks, and implement necessary changes to maintain compliance. By fostering a culture of accountability and transparency, the Regulatory Compliance team strives to minimize compliance risks and enhance the quality of care provided to members, ultimately supporting Humana's mission to improve health outcomes and consumer experiences. The Medicaid Compliance Officer (Compliance Lead) serves as the primary regulatory compliance contact for the Indiana Medicaid contract, overseeing the compliance landscape for Humana's Indiana Medicaid operation. This position involves navigating an extremely complex regulatory environment, conducting risk assessments and audits, and driving initiatives that align with both state and federal guidelines. The Compliance Lead collaborates closely with market leaders and corporate stakeholders to ensure that compliance protocols are not only met but continuously improved.

Requirements

• Bachelor's Degree.
• 8 or more years in regulatory compliance, CMS regulations, and/or working with Medicaid/Medicare.
• 2 or more years of experience in project leadership.
• Ability to lead and conduct audits.
• Able to travel up to 15%, once per month to meet with the State for 2-4 days.
• A strong commitment to enhancing consumer experiences within the organization.
• Advanced proficiency in building, collecting, validating, and communicating large datasets.

Nice To Haves

• Advanced graduate degree (JD, Masters, and/or equivalent).
• Project Management Professional (PMP) certification.
• Six Sigma certification.
• Demonstrated leadership experience within a healthcare or compliance setting.
• Ideal candidate would reside in Indianapolis and/or Indiana.

Responsibilities

• Participate in external audits, including monthly state contract audits, and coordinate with regulators as needed.
• Serve as the subject matter expert on the Indiana Medicaid statement of work/contract by providing operational interpretation and guidance on the content.
• Conduct thorough risk assessments and develop actionable plans to mitigate identified risks.
• Monitor ongoing Medicaid business operations to ensure compliance with regulatory standards.
• Analyze market documents and data to provide evidence of compliance efforts.
• Build and maintain relationships with market contacts and external regulators to facilitate communication.
• Serve as a liaison between Humana leadership and state and federal Medicaid/Medicare departments, clarifying regulatory intentions.
• Collaborate with various Humana operational units to enhance data analytics and operational improvements.
• Manage and standardize data related to regulatory compliance efforts.
• Coordinate compliance-related communications and interactions with external regulatory bodies.

Benefits

• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including company and personal holidays, volunteer time off, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree