Compliance Lead - Illinois Medicaid

Profile

Job Information

Humana

Compliance Lead - Illinois Medicaid

in

Pittsburgh

Pennsylvania

Description

The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Compliance Lead is responsible for the day to day management of compliance risk for the Illinois Medicaid Market.

Develops and implements compliance policies and procedures and monitor key market metrics.

Researches compliance issues and recommends changes that assure compliance with contract obligations and driving remediation.

Maintains relationships with government agencies and coordinates site visits for regulators.

Leads the implementation and compliance with corrective action plans.

Advises executives to develop functional strategies (often segment specific) on matters of significance.

Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Required Qualifications

Bachelor's Degree.

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.

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.

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.

Preferred Qualifications

5 years' experience in healthcare operations.

Master's degree in business, healthcare administration or related field.

Experience working with Illinois's government agencies.

Additional Information

Travel:

Note: There will be no travel at this time due to business travel restrictions. Business travel restrictions are scheduled to be lifted in October 2021.

If you live in IL, travel is up to 15% in Illinois and other states.

If you live outside of IL, the estimated travel into IL is once per month for 2 - 3days of stay as well as travel to other states.

Work Style:

Hybrid - Office (Schaumburg, IL) and/or Remote. Schedule and frequency will be determined by leadership.

Interview Format

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

40

Company info

Humana Inc.
Website : http://www.humana.com