Compliance Professional (Kentucky Medicaid)

Humana; Missouri; Remote; USD 65,000 - 89,000; Full time

Job summary

A leading healthcare company is seeking a Compliance Professional focused on Kentucky Medicaid operations. This remote position requires strong critical thinking and project management skills to ensure compliance with state regulations. The role encompasses supporting contract administration and maintaining relationships with regulators while analyzing data requests. Candidates should possess an associate degree and hold two to five years of relevant experience.

Benefits

Competitive benefits including medical, dental, and vision

401(k) retirement savings plan

Paid time off and holidays

Short-term and long-term disability

Life insurance

Qualifications

• Two years of related work experience in risk, compliance, or regulatory.
• Experience in healthcare or managed care for 2-5 years.
• Previous auditing experience preferred.

Responsibilities

• Support the KY Medicaid Market in contract administration.
• Analyze data requests from internal and external partners.
• Ensure accurate compliance responses to providers.

Skills

Critical Thinking

Interpersonal Skills

Communication Skills

Project Management

Education

Associate degree

Bachelor’s degree

Job description

Compliance Professional (Kentucky Medicaid)

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Compliance Professional (Kentucky Medicaid)

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This range is provided by Humana. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$65,000.00/yr - $88,600.00/yr

Become a part of our caring community and help us put health first

Humana Healthy Horizons in Kentucky is seeking a Compliance Professional 2 who will provide support to the Kentucky Medicaid plan, contract administration, operations compliance, and support of multiple state agency needs. The Compliance Professional 2 position is a market-focused position and work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Compliance Professional 2 serves as the primary resource on day-to-day contract administration activities, and the state agency requests to support the KY Medicaid Market.

• Supports the KY Medicaid Market in meeting or exceeding corporate Medicaid performance benchmarks.
• Works to build and maintain relationships with regulators within the state of KY.
• Analyzes data requests from internal and external business partners.
• Ensure responses to providers are accurate and in compliance with the statue and Kentucky Department of Medicaid Services (KDMS).
• Ensures compliance with materials distributed to providers.
• Provides timely delivery of internal and external requests.
• Submits members and providers materials to the state agency.
• Tracks and trends various deliverables
• Facilitates meetings to resolve issues.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Follows established guidelines/procedures.
  
  

Required Qualifications

Use your skills to make an impact

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

Preferred Qualifications

• Bachelor’s degree.
• 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 to attend onsite team engagement meetings.
• Workdays/Hours: Monday – Friday; 8:00am -5:00pm, Eastern Standard Time (EST).
  
  

WAH Internet Statement

To Ensure Home Or Hybrid Home/Office Employees’ Ability To Work Effectively, The Self-provided Internet Service Of Home Or Hybrid Home/Office Employees Must Meet The Following Criteria

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
  
  

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$65,000 - $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description Of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Finance and Sales

• Industries

  Insurance

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