Compliance Lead

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $115.2k - $158.4k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Ensure compliance with governmental requirements, focusing on Medicare Part C claims • Develop and implement compliance policies and procedures • Research compliance issues and recommend changes to meet contract obligations • Maintain relationships with government agencies • Coordinate regulator site visits • Coordinate implementation and compliance with corrective action plans • Advise executives on significant compliance matters and functional strategies • Research, understand, and apply laws, regulations, and regulatory guidance for Medicare Part C claims • Serve as subject matter expert on Medicare Part C claims • Develop audit methodology and perform auditing and monitoring activities • Provide guidance on remedial actions to strengthen compliance controls • Analyze business requirements and complex issues and provide regulatory guidance to business partners, Law, and Enterprise Compliance associates and leaders • Develop and track compliance metrics • Partner with Enterprise Compliance team members on regulatory outreach • Serve as Regulatory Compliance subject matter expert during CMS program audits • Lead onsite program audit preparation and activity • Oversee business audit preparation and submissions to regulators • Present monitoring and auditing findings and track issues through remediation • Lead and participate on committees • Provide backup and support to Enterprise Compliance team members • Report to an Associate Director of Compliance • Perform other duties as needed

🎯 Requirements

• Bachelor's Degree • 8 or more years of compliance or audit related experience • Advanced experience building, collecting, validating, and communicating large datasets • 2 or more years of regulatory compliance experience overseeing Medicare Part C claims • Advanced graduate degree preferred • Project Management Professional (PMP) certification preferred • Six Sigma certification preferred • Leadership experience preferred • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Self-provided internet service with at least 25 Mbps download and 10 Mbps upload • Ability to work remotely within the United States

🏖️ Benefits

• Bonus incentive plan • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Personal wellness support • Healthcare decision support for employees and families