Humana Compliance Lead (Medicaid Contract Administrator) - Remote, South Carolina in Beaufort, South Carolina
The Compliance Lead (Medicaid Contract Administrator) ensures compliance with governmental requirements, works on problems of diverse scope and complexity ranging from moderate to substantial. The Compliance Lead (Medicaid Contract Administrator) requires a solid understanding of how organization capabilities interrelate across department(s).
The Compliance Lead (Medicaid Contract Administrator) develops and implements compliance policies and procedures. Researches compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with government agencies. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. May be over privacy staff also. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple associates or highly specialized professional associates.
Key Role Objectives
Responsible for day-to-day management of State Agency relationships to support business compliance with contractual requirements, establishing effective and responsive lines of communication to address inquiries timely.
Develop portfolio management structure to evaluate and assess operational process risks and dependencies across all health plan functions to support continuous performance improvement with contractual compliance measures.
Lead the development of procedures and administrative policies to facilitate effective operation for Medicaid, Dual & LTSS services including outreach, membership enrollment, provider services, quality, grievance and appeals, etc.
Lead implementation strategy for programmatic and contractual changes that impact the delivery of Medicaid, Dual & LTSS services.
Act in a strategic capacity to support and inform business development strategy for Medicaid, Dual & LTSS services.
In partnership with Medicaid Compliance Reporting team, monitor the routine report submissions (monthly, weekly, etc.) to ensure timeliness and accuracy of reporting against contractual requirements. Ensure all reports are reviewed, quality checked, and submitted to the State in a timely manner.
5+ years' experience in auditing, consulting or compliance-related field.
Previous leadership experience.
Experience working with regulatory agencies, including state departments of health insurance and/or CMS.
Experience working with South Carolina's government agencies.
Ability to use metrics and other resources to identify improvement opportunities, assess strategic operations and translate data into tactical operational plans to achieve targeted outcomes.
Strong commitment and proven track record in providing excellent customer service to all stakeholders.
Track record in team-building and relationship management with internal and external customers; excellent facilitation and collaboration skills.
Proven ability to operate within a fast-growth environment and achieve a timely, effective response to complex issues.
The ideal candidate must reside in the state of South Carolina.
Must have a separate room with a locked door that can be used as a home office, to ensure you have absolute and continuous privacy while you work.
Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
5+ years' experience in healthcare operations.
Master's degree in business, healthcare administration or related field.
Days/Hours: Monday - Friday; 8:30am - 5:00pm, Eastern Standard Time.
Travel: up to 25% (There will be no travel at this time due to business travel restrictions.)
Work Location: Remote position but once business travel restrictions are lifted, travel is required to Humana's Columbia, South Carolina location
As part of our hiring process, we will be using an exciting interviewing technology provided by Montage/Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours