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The Risk Adjustment Compliance Principal will support horizontal teams throughout the Risk Adjustment organization and the enterprise - including members from Actuarial, Government Affairs, and the Clinical organizations. The Principal will create engagement to evaluate risk adjustment policies and program changes proposed by CMS.

Humana must improve its advocacy work on future risk adjustment methodology to support the long-term success and financial viability of the Medicare Advantage program. The Risk Adjustment Compliance Principal will support horizontal teams throughout the Risk Adjustment organization and the enterprise - including members from Actuarial, Government Affairs, and the Clinical organizations. The Principal will create engagement to evaluate risk adjustment policies and program changes proposed by CMS. You will also be an expert. This expert will support proactive evaluations of risk adjustment program policies and industry ideas. These evaluations will inform Humana's Government affairs and public policy team, along with risk adjustment leaders at Humana, of how proposed policies may improve Humana's insurance segment. Also, the Risk adjustment Compliance Principal will increase creative idea generation when considering the possibilities that CMS's Medicare Advantage Risk Adjustment program will undergo regarding future changes. You will be an important advisor to leaders at Humana, including the SVP of Risk Adjustment, Humana's Chief Actuary, and VP of Public Policy. You will support Humana to position themselves as an industry leader in influencing future Risk Adjustment policy and methodology through industry channels. The Risk Adjustment Compliance Principal will help prepare Humana for future Risk Adjustment changes to minimize impact to customer experiences and outcomes. You will report to Associate VP, Risk Adjustment Compliance and be apart of Humana's Risk Adjustment organization.

Use your skills to make an impact

• Evaluate and propose risk adjustment program policies and to communicate impacts to the enterprise's financial and business operations
• Inform and influence senior leaders on evaluation and influence of risk adjustment policies and methodologies while considering approach to influence industry to shape future risk adjustment policy
• Introduce solutions to complex risk adjustment problems that has impact on Humana's insurance segment and future risk adjustment policy
• Lead Humana to become a stronger in the industry to support future risk adjustment policy
• Support response efforts to CMS proposals, changes and requests for information.

Use your skills to make an impact
 

Required Qualifications

• 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

Preferred Qualifications

• Background
• Experience in previous compliance, policy, or government affairs teams
• Experience working with CMS

Work at Home Requirements To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

 

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$138,900 - $191,000 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.