Compliance Lead

The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Compliance Lead serves as the dedicated Compliance Officer for South Carolina to 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.

As a Compliance Lead for our Medicaid business, you will be part of a team who develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners and oversight agencies. While working within assigned areas to optimize business results, you will:

• Serves as dedicated Regulatory Compliance Officer for South Carolina Medicaid contract.
• Build relationships with market leadership teams and external regulators.
• Provide ongoing oversight of Medicaid operations from readiness review through contract duration to ensure full compliance and minimize risk for the Enterprise.
• Perform risk assessments, develop and implement annual regulatory compliance auditing and monitoring work plans, oversee corrective action plans and document remediation activities.
• Interpret and define state and federal regulatory and contract requirements for Humana Departments and/or external business partners and provide ongoing guidance.
• Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards.
• Participate in external audits to review document submissions, prepare presenters, and coordinate responses for regulators, as necessary.
• Work across Humana operational units and product lines to enhance compliance data analytics and operational improvement efforts.
• Coordinate and manage a standard set of data relating to regulatory standards and report compliance issues to senior leadership and compliance oversight committees.
• Chair the South Carolina Compliance Committee per approved charter.
• Coordinate compliance related communication/interaction with outside regulators, as necessary.
• Coordinate with the Special Investigations Unit (SIU) to operate and effective fraud, waste and abuse program integrity program.

• Demonstrated ability to communicate with clarity, professionalism, and impact across internal and external stakeholder groups, both verbally and in writing.

• Bachelor's degree in related field
• 3+ years of advanced experience working in a Compliance-related or managed care-related field or Medicaid
• 3+ years of interpreting and guiding on regulations and compliance requirements governing the health care industry.
• 3 or more years analyzing and reviewing metrics related to contract compliance

• Juris Doctor and/or advanced degree
• Audit experience
• Experience with metrics and reporting
• Experience working with regulatory agencies, including state departments of health insurance and/or CMS

• This role is only open to South Carolina applicants, strong preference for those in Columbia, South Carolina.
• In this role you will report to the Associate Director of Compliance.
• This role is an individual contributor.

Work at Home:
Employees must provide a minimum download speed of 25 Mbps and an upload speed of 10 Mbps. Employees must work from a dedicated space that protects member privacy.

Travel:
Occasional travel to Humana's offices for training or meetings may be required.

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.

$115,200 - $158,400 per year. This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Humana, Inc. and its affiliated subsidiaries (collectively,…