Compliance Professional, Medicaid Managed Care

Compliance Professional

Humana Healthy Horizons is hiring a Compliance Professional who will support efforts for overall Medicaid business by joining the team overseeing the facilitation of Policy Governance. The Policy Governance team coordinates ad hoc as well as annual updates to all Medicaid policies across business units and across states. This core function is crucial to Humana ensuring that all Medicaid policies are accurate, up-to-date and reviewed annually, at a minimum.

This is a fully remote, work from home position.

The Policy Governance Compliance Professional works to ensure accurate and updated policy content for Medicaid. The Compliance Professional will work collaboratively with business partners to facilitate policy updates throughout the year as well as during annual review. This position requires strong technical skills to leverage the designated system for policy maintenance, as well as strong relationship skills in working collaboratively with business partners.

Key responsibilities for this role include:

• Effectively working with business partners from all levels and all business areas throughout Humana.
• Performing ad hoc and annual updates to policies and ensuring assigned state-specific reporting is completed timely and accurately.
• Becoming an expert in using the designated system for ad hoc and annual policy updates, so to be able to perform trainings for business partners on use of the system and answer business partner questions.
• Approaching Policy Governance with a lens of process improvement of how the team can continue driving efficiency and standardization in policies and procedures.
• Assisting with drafting and sending policy-related communications to business partners.
• Escalating to management any policy-related questions or situations, as necessary.
• Other related activities, as assigned by management.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree or 2 years of equivalent professional experience.
• 2+ years of project management experience.
• 2+ years of experience in an audit, compliance, or regulatory role within a managed care environment.
• Medicaid experience.
• Written and verbal communication skills with the ability to communicate information clearly and effectively.
• Demonstrated organizational skills, including the ability to manage multiple projects simultaneously and ensure timely, accurate deliverables.
• Demonstrated ability to build and maintain positive cross-functional relationships and facilitate collaboration and consultation across teams.

Preferred Qualifications

• Advanced or graduate degree.
• Policy management experience.
• Professional certification, such as:
  Certified Public Accountant (CPA), Certified Information Systems Auditor (CISA), Certified Internal Auditor (CIA), Project Management certification, Healthcare Compliance certification.
• Medicaid healthcare insurance compliance and regulatory experience.
• Understanding of Humana's operations, technology, communications, processes, and related interdependencies.
• Experience interpreting Medicaid contracts.
• Residence within the Eastern or Central time zones.

Additional information

• Schedule/Time Zone: Monday through Friday, 8:00 AM – 5:00 PM Eastern Time (ET), regardless of where you reside.
• Work Location: U.S. Nationwide
• Work Style: Remote
• Travel Requirements: Minimal travel. Occasional internal team meetings may be required, estimated at less than 5% annually.

Work at Home Requirements:
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours 40

Pay Range $65,000 - $88,600 per year

This 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other…