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The Compliance Lead serves as the dedicated Compliance Officer for Louisiana 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 fast-growing 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:

As a Compliance Lead for our Medicaid business, you will be part of a fast-growing team who develops and maintains key relationships both internally with Humana operational leaders as well as externally with our business partners, the State Medicaid Office and/or the Centers for Medicare and Medicaid Services (CMS). While working within assigned areas to optimize business results, you will:

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

Use your skills to make an impact
 

• Bachelor’s degree or higher in Public Policy, Public Health, or related field
• Minimum of 5+ years experience working in a Compliance-related or managed care-related field or Medicaid
• Minimum of 3+ years experience in regulations governing health care industries
• Demonstrated written and verbal communication skills for presenting to various levels of Leadership and audiences

Preferred Qualifications

• Juris Doctor and/or advanced degree
• Audit experience
• Advanced experience with metrics and reporting
• Experience working with regulatory agencies, including state departments of health insurance and/or CMS
• Knowledgeable in process improvement

Additional Information

WAH Internet Statement
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. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
 

Travel: While this is a remote position, occasional tr