Compliance Lead

Profile

Description

The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead will 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. Responsible for completing risk assessments, creating annual work plans to audit and monitor plan performance, and for supporting the implementation of new contracts through readiness review activities. May directly manage and/or give day-to-day work direction to other Compliance Associates.

Responsibilities

Humana is seeking a Compliance Lead to assist with the development and implementation of Medicaid compliance program oversight and monitoring plans, which includes completing risk assessments and creating annual work plans to audit and monitor performance for Humana Medicaid contracts. The Compliance Lead facilitates process consistency across contracts and performs ongoing functions to ensure compliance with internal initiatives as well as federal and state regulations. This position will support Medicaid business growth by contributing to implementation and readiness review activities for newly awarded contracts. 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, the State Medicaid Office and/or the Centers for Medicare and Medicaid Services (CMS). While working within assigned areas to optimize business results, you will:


Support Medicaid business growth by contributing to implementation and readiness review activities for newly awarded contracts;
Provide on-going oversight and monitoring of Medicaid business operations to ensure full compliance and minimize risk for the Enterprise;
Assist with completion of risk assessments and create annual work plans to audit and monitor performance;
Interpret and define regulatory and contract requirements to be implemented by appropriate Humana Departments and/or external business partners in support of Medicaid;
Coordinate and manage a standard set of data relating to regulatory standards;
Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards;
Communicate with and present to outside regulators;
Work across Humana operational units and product lines to enhance data analytics and operational improvement efforts;
Build relationships with Medicaid market and shared services business units;
Complete special projects as assigned by Associate Director in support of team objectives and other strategic initiatives.
May directly manage and/or give day-to-day work direction to other Compliance Associates.


Required Qualifications


Bachelor's degree in related field
3 years experience working in a Compliance-related or managed care-related field
Experience working with regulatory agencies, including state departments of health insurance and/or CMS
Knowledgeable in process improvement and metrics development
Knowledgeable in regulations governing health care industries
Strong communication skills


Preferred Qualifications


Juris Doctor or Masters of Business Administration
Experience in Health Plan Operations
Leadership experience


Additional Information

Scheduled Weekly Hours

40

Company info

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