The Compliance Lead ensures compliance with governmental requirements. The Compliance Lead works on problems of diverse scope and complexity ranging from moderate to substantial.
The Compliance Lead 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. Responsible for hiring, training, and firing staff. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
+ Bachelor's Degree
+ 8 or more years of technical experience
+ 2 or more years of project leadership experience
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
+ Advanced experience with building, collecting, validating, and communicating large sets of data
+ Experience working with Clinical Providers Offices
+ Experience in Revenue Cycle reviews
+ Experience in Risk Adjustment and False Claim documentation and coding auditing
+ CRC an/or CPC certified
+ Project Management Professional (PMP) certification
+ Six Sigma certification
+ Experience in an audit or compliance role
+ Leadership experience
Scheduled Weekly Hours
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
Equal Opportunity Employer
It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.
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