Compliance Professional 2 - Kentucky Medicaid

Employment Type: Full-time

Position Overview

Humana Healthy Horizons in Kentucky is seeking a Compliance Professional 2 to provide essential support to the Kentucky Medicaid plan. This role involves contract administration, operations compliance, and assisting with various state agency needs. As a market-focused position, the Compliance Professional 2 will handle diverse work assignments requiring interpretation and independent decision-making. This role is crucial for supporting the KY Medicaid Market in meeting or exceeding corporate Medicaid performance benchmarks and building strong relationships with Kentucky state regulators.

Responsibilities

• Serve as the primary resource for day-to-day contract administration activities and state agency requests supporting the KY Medicaid Market.
• Analyze data requests from internal and external business partners.
• Ensure accuracy and compliance with statutes and the Kentucky Department of Medicaid Services (KDMS) for provider responses.
• Ensure compliance of materials distributed to providers.
• Provide timely delivery of internal and external requests.
• Submit member and provider materials to the state agency.
• Track and trend various deliverables.
• Facilitate meetings to resolve issues.
• Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Follow established guidelines and procedures.

Requirements

• Residency: Must reside in Kentucky, Indiana, Illinois, Missouri, Ohio, Tennessee, Virginia, or West Virginia.
• Education: Associate degree.
• Experience:
  • Two (2) years of work-related experience (risk, compliance, regulatory, or related experience).
  • Two (2) to five (5) years of healthcare or managed care experience.
  • Previous auditing experience working with auditing functions within compliance or other related experience.
• Skills:
  • Project management skills.
  • Strong critical thinking, interpersonal, and communication skills.

Preferred Qualifications

• Education: Bachelor’s degree.
• Experience: Two (2) years of law, risk, compliance, internal audit, public audit, or project management experience.
• Knowledge of Humana’s cultural values, products, policies, and procedures.

Additional Information

• Workstyle: This is a remote position with minimal travel.
• Travel: Occasionally to Louisville, KY for onsite team engagement meetings.
• Workdays/Hours: Monday – Friday; 8:00 am - 5:00 pm, Eastern Standard Time (EST).
• Internet Service: Minimum download speed of 25 Mbps and upload speed of 10 Mbps is required. Wireless, wired cable, or DSL connection is suggested. Satellite, cellular, and microwave connections may be used only if approved by leadership.
  • Note: Employees in California, Illinois, Montana, or South Dakota will receive a bi-weekly internet expense payment.
• Equipment: Humana will provide appropriate telephone equipment.
• Work Environment: Must work from a dedicated, interruption-free space to protect member PHI/HIPAA information.
• Interview Format: Interviews will be conducted using HireVue technology.

Company Information

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Pay Range

The compensation range provided reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment.