Compliance Lead

About the role

The Compliance Lead serves as the dedicated Compliance Officer for Kentucky 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:

• Serve as dedicated Regulatory Compliance Officer for Kentucky 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 and manage 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 Kentucky Compliance Committee per approved charter.
• Coordinate compliance-related communication/interaction with outside regulators, as necessary.
• Coordinate with the Special Investigations Unit (SIU) to operate an effective fraud, waste, and abuse program integrity program.

Requirements

• Bachelor's degree in a related field.
• 7+ 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 healthcare industry.
• 3 or more years analyzing and reviewing metrics related to contract compliance.

Preferred Qualifications

• 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.

Skills

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

Additional Information

This role is only open to Kentucky applicants. You must be available to meet with regulators at a location in the Commonwealth they specify with twenty-four (24) hours’ notice. In this role, you will report to the Associate Director of Compliance. This role is an individual contributor.

Pay

The pay range for this role is $115,200 - $158,400 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.

Schedule

Scheduled weekly hours: 40.

Benefits

Humana offers competitive benefits that support whole-person well-being, including:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.