Remote Program Integrity Contract Lead

Humana Inc; Olympia (WA); Remote; USD 95,000 - 131,000; Full time

Benefits offered by this job

Remote work

Travel flexibility

Job summary

Humana Inc. is seeking a PI Contract Lead to oversee program integrity and contract compliance across enterprise processes. You will analyze and improve business workflows, develop implementation plans, and partner with Compliance and cross-functional teams to address risks and gaps.

The role emphasizes root-cause analyses, actionable recommendations, and clear communication with senior leadership. It is a remote position with periodic travel, delivering measurable improvements and ensuring

Qualifications

• 5 or more years of Program Integrity and/or Payment Integrity experience
• 2 or more years of project management (Ideally in implementing large contracts) experience
• Must have ONE of the following ant-fraud degrees, designations, and/or certifications: RN/BSN, CPC, CCS, CCDS, CHC, HCAFA, AHFI, CFE, or 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 include the ability to communicate and present technical details to senior and executive level leadership
• Results-driven mindset with the ability to achieve established individual and organizational goals

Responsibilities

• Translate contract requirements into business processes, workflows, controls, procedures, and operational requirements.
• Develop implementation workplans, milestones, dependencies, risks and readiness criteria for projects
• Identify operational gaps and recommend process changes necessary to meet contractual requirements.
• Support development of standard operating procedures, desk level procedures, workflows, job aids and training materials.
• Establish and maintain an ongoing contract monitoring framework to ensure continued compliance with contractual requirements.
• Monitor contract performance, service level agreements, key performance indicators, deliverables, milestones, and operational commitments.
• 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.

Skills

Program Integrity

Project Management

Claims Adjudication Understanding

Communication Skills

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 oversee program integrity and contract compliance across enterprise processes. You will analyze and improve business workflows, develop implementation plans, and partner with Compliance and cross-functional teams to address risks and gaps.

The role emphasizes root-cause analyses, actionable recommendations, and clear communication with senior leadership. It is a remote position with periodic travel, delivering measurable improvements and ensuring