Remote Contract Integrity Lead – Healthcare Compliance

Humana Inc; Boise (ID); Remote; USD 95,000 - 131,000; Full time

Benefits offered by this job

Remote work

Occasional travel

Job summary

Humana Inc. is seeking a PI Contract Lead to join the Program Integrity leadership team.

The role requires deep knowledge of CCN program, FAR, FCA, and healthcare regulations, with responsibility to translate contract requirements into compliant processes and to lead cross-functional improvements. You will conduct root-cause analyses, develop action plans, and provide training and briefings to stakeholders, while maintaining contract data, supporting data teams, and ensuring performance against

Qualifications

• 5+ years of Program Integrity and/or Payment Integrity experience.
• 2+ years of project management experience, ideally with large contracts.
• Must have ONE of the listed ant-fraud degrees, designations, and/or certifications (RN/BSN, CPC, CCS, CCDS, CHC, HCAFA, AHFI, CFE, JD).
• 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 senior and executive level leadership.
• U.S. citizenship and eligibility for government security clearance (NBIS).
• Puerto Rico work restriction under government contract.

Responsibilities

• 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 for compliance and performance.
• Apply Lean, Six Sigma, root cause analysis and other methodologies to improve operations and contract performance.
• Conduct routine reviews of contract requirements to ensure alignment with obligations.

Skills

Program Integrity

Project management

Lean Six Sigma

Root cause analysis

Data analysis

Communication skills

Microsoft Excel

PowerPoint

Word

Education

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Tools

Excel

PowerPoint

Word

Job description

Humana Inc. is seeking a PI Contract Lead to join the Program Integrity leadership team.

The role requires deep knowledge of CCN program, FAR, FCA, and healthcare regulations, with responsibility to translate contract requirements into compliant processes and to lead cross-functional improvements. You will conduct root-cause analyses, develop action plans, and provide training and briefings to stakeholders, while maintaining contract data, supporting data teams, and ensuring performance against