Manager, Compliance - Medicaid State Reporting

at  Humana

BECOME A PART OF OUR CARING COMMUNITY AND HELP US PUT HEALTH FIRST

Humana Healthy Horizons is seeking a Manager, Compliance - Medicaid State Reporting to ensure compliance with governmental requirements across the organization. This leader will work within specific guidelines and procedures, apply advanced technical knowledge to solve moderately complex problems, and will receive assignments in the form of objectives to determine approach, resources, schedules, and goals.
The Manager, Compliance - Medicaid State Reporting develops and implements compliance policies and procedures, and researches compliance issues as they relate to reporting.

Roles and responsibilities for this position include (not all inclusive):

• Maintains relationships with Market compliance teams.
• Coordinates implementation of new Medicaid markets and compliance with corrective action plans, as needed.
• Recommends changes that assure compliance with contract obligations.
• Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving Medicaid State Reporting.
• Requires cross departmental collaboration and conducts briefings and area meetings.
• Maintains frequent contact with other managers across the department.

REQUIRED QUALIFICATIONS

• Must reside in the eastern or central time zones within the contiguous United States.
• Bachelor’s Degree OR Equivalent Work Experience of 5+ years of healthcare, insurance, and/or financial services experience.
• 2+ years of people or project/process management leadership.
• 5+ years of Compliance, Policy, Risk, and/or Audit experience.
• Prior health insurance industry experience.
• Comprehensive working knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint.
• Proven experience to manage multiple projects/assignments while working with various departments to obtain data.
• Strong attention to detail and ability to work in a deadline-driven organization.
• Success in developing and managing working relationships within a highly matrixed business environment.

WORK AT HOME REQUIREMENTS

• 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.
• 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 / HIPAA information.

PREFERRED QUALIFICATIONS

• Graduate or advanced degree.
• Prior experience analyzing data and metrics to influence change in departmental processes.
• Experience in data visualization tools (Power BI, Tableau, etc.).
• Experience with Enterprise Solution Point (ESP).
• Medicaid experience/knowledge.

DESCRIPTION OF BENEFITS

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

ABOUT US

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

• Maintains relationships with Market compliance teams.
• Coordinates implementation of new Medicaid markets and compliance with corrective action plans, as needed.
• Recommends changes that assure compliance with contract obligations.
• Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving Medicaid State Reporting.
• Requires cross departmental collaboration and conducts briefings and area meetings.
• Maintains frequent contact with other managers across the department