Remote Contract Integrity Lead – Health Care Compliance

Humana Inc; Atlanta (GA); À distance; USD 95 000 - 131 000; Plein temps

Résumé du poste

Humana, Inc. is hiring a Program Integrity Contract Lead to join the remote leadership team, focused on compliance with CCN and federal/state requirements. You will analyze processes, drive measurable improvements, and advise on corrective actions with cross-functional stakeholders.

Responsibilities include contract data reporting, risk assessment, and governance development. The role requires strong communication, Lean/Six Sigma experience, and the ability to lead multiple initiatives with

Qualifications

• 5+ years of Program Integrity or Payment Integrity experience.
• 2+ years of project management experience on large contracts.
• Must have ONE of the following ant-fraud degrees, designations, and/or certifications.
• Current experience with understanding claims adjudication, systems and reporting.
• Knowledge in healthcare related applications and technology.
• Ability to manage and prioritize multiple initiatives with minimal guidance.
• Excellent communication and presentation skills to include the ability to communicate and present technical details to senior and executive level leadership.

Responsabilités

• Translate contract requirements into business processes, workflows, controls, procedures, and operational requirements.
• Identify operational gaps and recommend process changes necessary to meet contractual requirements.
• Establish and maintain an ongoing contract monitoring framework to ensure continued compliance with contractual requirements.
• Apply Lean, Six Sigma, root cause analysis and other process improvement methodologies to improve operational and contract performance.
• Conduct routine reviews of contract requirements to ensure operational processes remain aligned with current contractual obligations.

Connaissances

Program Integrity

Project Management

Communication Skills

Analytical Thinking

Formation

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Outils

MS Office Suite

Excel

PowerPoint

Word

Description du poste

Humana, Inc. is hiring a Program Integrity Contract Lead to join the remote leadership team, focused on compliance with CCN and federal/state requirements. You will analyze processes, drive measurable improvements, and advise on corrective actions with cross-functional stakeholders.

Responsibilities include contract data reporting, risk assessment, and governance development. The role requires strong communication, Lean/Six Sigma experience, and the ability to lead multiple initiatives with