Remote Program Integrity Lead - Contracts & Compliance

Humana Inc; Santa Fe (NM); À distance; USD 95 000 - 131 000; Plein temps

Résumé du poste

Humana Inc. seeks a PI Contract Lead to lead cross-functional compliance activities, translating contract requirements into scalable processes while guiding error-free execution and governance.

You will partner with compliance leadership to implement corrective actions, monitor performance, and escalate risks with actionable recommendations. Ideal candidates bring 5+ years in program integrity, project management experience, and certification or degree in healthcare compliance or related fields.

Qualifications

• 5+ years of Program Integrity and/or Payment Integrity experience.
• 2+ years of project management experience (ideally in large contract implementations).
• 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 senior/executive leadership.
• Results-driven mindset and data-driven problem solving.

Responsabilités

• Translate contract requirements into business processes, workflows, controls, procedures, and operational requirements.
• Identify operational gaps and recommend process changes to meet contractual requirements.
• Establish and maintain a contract monitoring framework for compliance and performance.
• Apply Lean, Six Sigma and root cause analysis to improve operations and contract performance.
• Conduct routine reviews of contract requirements to ensure alignment with obligations.

Connaissances

Program Integrity experience

Project management

Communication skills

Healthcare compliance

Data analysis

US citizenship

Formation

RN/BSN

CPC

CCS

CCDS

CHC

HCAFA

AHFI

CFE

JD

Outils

Excel

PowerPoint

Word

Description du poste

Humana Inc. seeks a PI Contract Lead to lead cross-functional compliance activities, translating contract requirements into scalable processes while guiding error-free execution and governance.

You will partner with compliance leadership to implement corrective actions, monitor performance, and escalate risks with actionable recommendations. Ideal candidates bring 5+ years in program integrity, project management experience, and certification or degree in healthcare compliance or related fields.