Director of Risk Adjustment Regulatory Audits

🔥 51 minutes ago

🇺🇸 United States – Remote

💵 $150k - $206.3k / year

⏰ Full Time

🔴 Lead

🚔 Compliance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• Develop strategy and execute Humana’s external risk adjustment regulatory audits • Establish operational processes for regulatory audit intake • Communicate with regulatory bodies throughout the audit process • Ensure all records are submitted for regulatory audits • Analyze audit performance and results to drive future improvements • Develop and maintain reporting and tracking for all risk adjustment regulatory audits • Determine strategic approaches to respond to regulatory audits • Identify improvement opportunities in external regulatory risk adjustment audits • Leverage partnerships with Quality Cost & Strategy, market risk adjustment associates, legal, regulatory compliance, and other Humana associates • Drive analytics development and execution using audit data and results to inform future strategy • Implement technology-based solutions to improve audit workflow efficiency and accuracy • Establish and manage team goals, priorities, staffing, and budgets • Develop strong cross-functional relationships and lead regulatory audit execution • Evaluate organizational resources and determine future enhancements • Drive a positive culture embodying the Humana Way • Report to the Associate VP, Risk Adjustment Compliance

🎯 Requirements

• 5+ years of project and people leadership experience • 8–10+ years of experience in strategic operations and analytics, including process improvement and stakeholder influence • 5+ years of experience in program development and management, leveraging metrics and performance reporting to track results • 5+ years of process improvement and operations experience • Experience communicating with external regulators • Experience presenting to senior leadership • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Must not require work visa sponsorship

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Remote work arrangement • Occasional travel to Humana offices for training or meetings • Competitive benefits supporting whole-person well-being • Dedicated workspace and internet requirements to support effective work and protect PHI/HIPAA information