Become a part of our caring community and help us put health first
Humana Healthy Horizons is seeking a Compliance Lead (Medicaid State Reporting) to ensure compliance with governmental requirements for new Medicaid market implementations. This leader will work within specific guidelines and procedures, apply advanced technical knowledge to solve moderately complex problems, and will receive assignments in the form of objectives to determine approach, resources, schedules, and goals.
The Compliance Lead role will be responsible for implementing new Medicaid markets for the Medicaid State Reporting team.
Roles and responsibilities for this position include (not all inclusive):
Maintains relationships with government agencies.
Implements new Medicaid market state reporting policies and procedures.
Coordinates site visits for state regulators.
Coordinates implementation of new Medicaid markets and compliance with corrective action plans, as needed.
Recommends changes that assure compliance with contract obligations.
Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving Medicaid State Reporting.
Requires cross departmental collaboration, conducts briefings and area meetings.
Use your skills to make an impact
Required Qualifications
Must reside in the eastern or central time zones within the contiguous United States.
See AlsoVirginia man 'disheartened' it took the state 8 months to investigate 'horrifying' nursing home conditionsHuman Services officials provide explanation on Medicaid waiver, childcare subsidyNearly 3 million people cut from Medicaid coverage even though many might still be eligibleLayoffs. Programs eliminated. What’s going on at Valley Community Services Board?Bachelor's Degree OR Equivalent Work Experience of 5+ years of healthcare, insurance, and/or financial services experience.
2+ years of project/process leadership experience.
4+ years of Compliance, Policy, Risk, and/or Audit experience.
Prior health insurance industry experience.
Comprehensive working knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint.
Proven experience collaborating with various departments to build, collect, validate, and communicate large sets of data.
Strong attention to detail and ability to work in a deadline-driven organization.
Success in developing and managing working relationships within a highly matrixed business environment.
Work at Home Requirements
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Preferred Qualifications
Graduate or advanced degree.
PMP
Prior experience analyzing data and metrics to influence change in departmental processes.
Experience in data visualization tools (Power BI, Tableau, etc.).
Experience with Enterprise Solution Point (ESP).
Medicaid experience/knowledge.
Additional Information:
Workstyle: Remote
Direct Reports: 1-5
Location: Must reside in the eastern or central times zones in the contiguous United States.
Core Workdays & Hours: Typically, Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST).
Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.
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.$102,200 - $140,700 per yearThis 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
