Remote Director, Risk Adjustment Regulatory Audits

Humana Inc; Austin (TX); Remote; USD 150,000 - 206,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a Director of Risk Adjustment Regulatory Audits to lead strategy and execution of external audits, ensuring strong operational processes and timely submissions.

The role reports to the Associate VP, Risk Adjustment Compliance and works in a remote capacity with occasional travel to Humana offices. You will drive analytics of audit data, collaborate across Quality Cost & Strategy, and leverage technology to improve efficiency.

Qualifications

• 5+ years of project and people leadership experience.
• 8-10+ years of experience in strategic operations, analytics, including process improvement and stakeholder influence.
• 5 + years of experience in program development and management, leveraging metrics and performance reporting to track results.
• 5 + years of process improvement and operations experience.

Responsibilities

• Successful execution of regulatory risk adjustment audits minimizing financial impacts to Humana through strong operational execution.
• Develop and maintain strong reporting and tracking of all risk adjustment regulatory audits.
• Determine strategic approaches to respond to regulatory audits.
• Identify areas of opportunity for improvement in external regulatory risk adjustment audits and leveraging key partnerships with Quality Cost & Strategy partners, market risk adjustment associates, and other associates across Humana, including legal and regulatory compliance partners.
• Drive development and execution of analytics of audit data and results to inform future strategy to minimize Humana’s risk regarding risk regarding risk adjustment data.
• Implement technology based solutions to drive improved efficiency and accuracy of audit workflows and processes.
• Manage communication with regulatory bodies throughout the audit process.
• Establish and manage goals, priorities, staffing and budgets for the team.
• Strong influencing and collaboration skills
• Excellent communication skills, both oral and written

Skills

People leadership

Strategic operations

Analytics

Stakeholder influence

Job description

Humana Inc. is seeking a Director of Risk Adjustment Regulatory Audits to lead strategy and execution of external audits, ensuring strong operational processes and timely submissions.

The role reports to the Associate VP, Risk Adjustment Compliance and works in a remote capacity with occasional travel to Humana offices. You will drive analytics of audit data, collaborate across Quality Cost & Strategy, and leverage technology to improve efficiency.