Humana Looking For Contract Compliance Officer (Louisiana Medicaid) – Baton Rouge, LA at Baton Rouge, LA Full Time

Humana Healthy Horizons in Louisiana is seeking a Contract Compliance Officer (Compliance Lead) who will ensure compliance with governmental requirements. The Contract Compliance Officer (Compliance Lead) works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Contract Compliance Officer (Compliance Lead) will provide strategic guidance for the development, implementation and operation of Humana’s Louisiana Medicaid Contract. They will serve as the primary point of contact for all Managed Care Organization (MCO) communications and requests related to the Contract, including (but not limited to) all compliance issues. The Contract Compliance Officer will report directly to the State Market Leader for Medicaid and other senior leadership on all contract performance and will manage the connection of MCO personnel to the Louisiana Department of Health (LDH) business owners. They will also develop and implement written policies, procedures, and standards to ensure compliance with requirements set forth in the Contract.

Essential Functions and Responsibilities

Ensures contract compliance with federal, state, and contractual requirements; collaborate with appropriate business areas to develop policies, procedures, and systems to secure and demonstrate compliance with all mandates.

Researches potential compliance issues and recommend changes that assure compliance with contract obligations.

Partner in the development and maintenance of policies and procedures.

Ensures the tracking and timely submission of all Contract deliverables.

Maintains relationships with relevant government agency contacts.

Participates in Louisiana program integrity and Medicaid compliance forums and programs.

Responds to LDH Contract compliance issues, including corrective action plans required to remedy contract issues.

Fields and coordinates responses to LDH inquiries.

Monitors and understands emerging Medicaid policy; provide recommendations and direction in the implementation of new initiatives to be compliant with emerging policy.

Coordinates the preparation and execution of Contract documents, audits, and ad hoc visits.

Works closely with internal and external auditors, financial investigators, and claims processing areas.

Required Qualifications

Bachelor’s Degree.

5+ years’ experience in auditing, consulting or compliance-related field.

Previous leadership experience.

Advanced experience with building, collecting, validating, and communicating large sets of data.

Experience working with regulatory agencies, including state departments of health and/or CMS.

This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Must have a separate room with a locked door that can be used as a home office, to ensure you have absolute and continuous privacy while you work.

Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10×1 (10mbs download x 1mbs upload) is required.

For this job, associates are required to be fully COVID vaccinated or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to: Provide proof of full vaccination OR Commit to weekly testing, following all CDC protocols, OR Provide documentation for a medical or religious exemption consideration. This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.

Preferred Qualifications

Master’s Degree or an advanced degree in business, law or a related field.

Experience working with Louisiana Department of Health(LDH) and/or CMS.

Additional Information

Workstyle: Hybrid Office – 3 – 4 days/week in Humana’s Baton Rouge, Louisiana location and 1 – 2/days per week remote. Leadership will discuss the frequency.

Travel: Up to 20% which includes travel to other state offices.

Direct Reports: Up to 3 Associates.

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40