Compliance Lead - Medicaid State Reporting

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 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.
• 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
• …