Compliance Professional - Medicaid Policy Governance

Employment Type: Full time Location Type: Fully Remote (Work from Home) Salary: Not Specified

Position Overview

Humana Healthy Horizons is seeking a motivated Compliance Professional to join the Policy Governance team. This role is crucial for supporting the overall Medicaid business by facilitating the coordination of policy updates, both ad hoc and annual, across all business units and states. The primary goal is to ensure all Medicaid policies are accurate, up-to-date, and reviewed at least annually.

Key Responsibilities

• Effectively collaborate with business partners from all levels and areas within Humana.
• Perform ad hoc and annual updates to policies and ensure timely and accurate completion of assigned state-specific reporting.
• Become an expert in the designated policy maintenance system, capable of training business partners and answering their system-related questions.
• Drive process improvement within Policy Governance to enhance efficiency and standardization of policies and procedures.
• Assist in drafting and distributing policy-related communications to business partners.
• Escalate policy-related questions or situations to management as necessary.
• Perform other related activities as assigned by management.

Required Qualifications

• Bachelor's Degree.
• 2+ years of project management experience.
• 2+ years of proven experience in an audit, compliance, or regulatory role within health insurance.
• Medicaid experience.
• Strong written and verbal communication skills, with the ability to communicate clearly.
• Demonstrated organizational skills, with the ability to manage multiple projects simultaneously and ensure timely, accurate deliverables.
• Proven ability to build and maintain positive cross-functional relationships and facilitate and consult across teams.

Preferred Qualifications

• Advanced or graduate degree.
• Policy management experience.
• Relevant certifications (e.g., CPA, CISA, CIA, PMP, Healthcare Compliance Certification).
• Medicaid health care insurance compliance/regulatory experience.
• Solid understanding of Humana's operations, technology, communications, processes, and their interconnectivity.
• Experience interpreting Medicaid contracts.
• Residing in the Eastern or Central time zones is preferred.

Work at Home Requirements

To ensure effective remote work, your internet service must meet the following criteria:

• Recommended Speed: Minimum download speed of 25 Mbps and upload speed of 10 Mbps.
• Connection Type: Wired cable or DSL connection is suggested. Satellite, cellular, and microwave connections may be used only with leadership approval.
• Internet Expense: Employees residing and working from home in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for internet expenses.
• Telephone Equipment: Humana will provide appropriate telephone equipment for business requirements.
• Work Environment: A dedicated space that lacks ongoing interruptions is required to protect member PHI/HIPAA information.