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Humana's Regulatory Compliance team is dedicated to ensuring that the organization adheres to all applicable laws, regulations, and contractual obligations governing its healthcare operations. This team plays a vital role in identifying, preventing, and addressing compliance issues by conducting thorough analyses of regulatory requirements and business practices. They work collaboratively with various internal departments and external partners to interpret regulations, assess risks, and implement necessary changes to maintain compliance. By fostering a culture of accountability and transparency, the Regulatory Compliance team strives to minimize compliance risks and enhance the quality of care provided to members, ultimately supporting Humana’s mission to improve health outcomes and consumer experiences.

The Medicaid Compliance Officer (Compliance Lead) serves as the primary regulatory compliance contact for the Indiana Medicaid contract, overseeing the compliance landscape for Humana's Indiana Medicaid operation. This position involves navigating an extremely complex regulatory environment, conducting risk assessments and audits, and driving initiatives that align with both state and federal guidelines. The Compliance Lead collaborates closely with market leaders and corporate stakeholders to ensure that compliance protocols are not only met but continuously improved.

This structure highlights the importance of the Medicaid Compliance Officer role while expanding on the responsibilities and qualifications necessary for success in this position.

Key Responsibilities

• Participate in external audits, including monthly state contract audits, and coordinate with regulators as needed.

• Serve as the subject matter expert on the Indiana Medicaid statement of work/contract by providing operational interpretation and guidance on the content.

• Conduct thorough risk assessments and develop actionable plans to mitigate identified risks.

• Monitor ongoing Medicaid business operations to ensure compliance with regulatory standards.

• Analyze market documents and data to provide evidence of compliance efforts.

• Build and maintain relationships with market contacts and external regulators to facilitate communication.

• Serve as a liaison between Humana leadership and state and federal Medicaid/Medicare departments, clarifying regulatory intentions.

• Collaborate with various Humana operational units to enhance data analytics and operational improvements.

• Manage and standardize data related to regulatory compliance efforts.

• Coordinate compliance-related communications and interactions with external regulatory bodies.

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree.

• 8 or more years in regulatory compliance, CMS regulations, and/or working with Medicaid/Medicare.

• 2 or more years of experience in project leadership.

• Ability to lead and conduct audits.

• Able to travel up to 15%, once per month to meet with the State for 2-4 days.

• A strong commitment to enhancing consumer experiences within the organization.

• Advanced proficiency in building, collecting, validating, and communicating large datasets.

Desired Qualifications

• Advanced graduate degree (JD, Masters, and/or equivalent).

• Project Management Professional (PMP) certification.

• Six Sigma certification.

• Demonstrated leadership experience within a healthcare or compliance setting.

• Ideal candidate would reside in Indianapolis and/or Indiana.

Additional Information

Work-At-Home Requirements:

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Associates 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 associates 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 / HIP