Director of Risk Adjustment Regulatory Audits

This is a fully remote position, open to applicants in United States.

📋 Description

• Formulate and implement the strategy for Humana’s external risk adjustment regulatory audits.

• Create operational procedures for the intake of regulatory audits.

• Engage with regulatory entities throughout the auditing process.

• Ensure that all documentation is provided for regulatory audits.

• Evaluate audit performance and outcomes to foster future enhancements.

• Develop and uphold reporting and tracking mechanisms for all risk adjustment regulatory audits.

• Identify strategic methods to address regulatory audits.

• Recognize opportunities for improvements in external regulatory risk adjustment audits.

• Utilize collaborations with Quality Cost & Strategy, market risk adjustment associates, legal, regulatory compliance, and other Humana team members.

• Propel the development and execution of analytics using audit data and results to guide future strategies.

• Implement technology-driven solutions to enhance the efficiency and accuracy of audit workflows.

• Establish and oversee team objectives, priorities, staffing, and budgets.

• Cultivate strong cross-functional relationships and lead the execution of regulatory audits.

• Assess organizational resources and identify future improvement opportunities.

• Foster a positive culture that embodies the Humana Way.

• Report directly to the Associate VP of Risk Adjustment Compliance.

⛳️ Requirements

• Over 5 years of experience in project and people leadership.

• 8–10+ years of strategic operations and analytics experience, including process enhancement and stakeholder engagement.

• More than 5 years in program development and management, utilizing metrics and performance reporting to monitor outcomes.

• Over 5 years of experience in process improvement and operations.

• Proven experience in communicating with external regulatory bodies.

• Skilled in presenting to senior leadership.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload.

• Ability to work from a dedicated area free from interruptions to safeguard member PHI/HIPAA information.

• Must not require sponsorship for a work visa.

🏝️ Benefits

• Bonus incentive program based on company and/or individual performance.

• Medical, dental, and vision insurance.

• 401(k) retirement savings plan.

• Paid time off.

• Company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Remote work flexibility.

• Occasional travel to Humana offices for training or meetings.

• Competitive benefits supporting overall well-being.

• Dedicated workspace and internet prerequisites to facilitate effective work and safeguard PHI/HIPAA information.