Risk Adjustment Compliance Principal

Job not on LinkedIn

🔥 4 hours ago

🇺🇸 United States – Remote

💵 $138.9k - $191k / year

⏰ Full Time

🔴 Lead

🚔 Compliance

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ 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

• support horizontal teams throughout the Risk Adjustment organization and the enterprise, including members from Actuarial, Government Affairs, and the Clinical organizations • create engagement to evaluate risk adjustment policies and program changes proposed by CMS • support proactive evaluations of risk adjustment program policies and industry ideas • inform Humana's Government affairs and public policy team on how proposed policies may improve Humana's insurance segment • introduce solutions to complex risk adjustment problems that impact Humana's insurance segment and future risk adjustment policy • lead Humana to become a stronger industry supporter of future risk adjustment policy • support response efforts to CMS proposals, changes, and requests for information

🎯 Requirements

• Bachelor's degree with at least 10 years of related experience • 5+ years of project leadership • Previous experience influencing policy and industry bodies • Experience with Medicare Advantage bid process • Medicare Risk Adjustment Knowledge • Expert known outside of Humana for involvement in supporting Humana regulatory/compliance-focused work • Knowledge of the healthcare environment and managed care

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance and many other opportunities