Associate Director, Regulatory Intake Compliance

Become a part of our caring community and help us put health first Responsible for enterprise-wide regulatory monitoring, including communication of new or amended regulations, as well as implementing and maintaining a quality assurance and validation process post-implementation.
Associate Director, Regulatory Intake Compliance is responsible for enterprise-wide regulatory monitoring, including communication of new or amended regulations, as well as implementing and maintaining a quality assurance and validation process post-implementation.
The Associate Director shall oversee a team of professional subject matter experts and further advise internal business units in a manner that demonstrates operational value and reduces compliance risk exposure for the organization.
The Associate Director, Regulatory Intake Compliance will be responsible for/to: Develop, execute, or maintain relevant policies, procedures, and workflows for the department operations Responsible for understanding and working within Enterprise Solution Point (ESP) data, including risk assessment and scoring methodology and reporting or dashboard management using the LRR module.
Responsible for ongoing analytics in support of ongoing process improvement.
Responsible for coordinating inter-departmental committees, forums or other meetings to achieve execution excellence.
Maintains relationships with internal and external stakeholders, including government regulators and external vendor partners.
Manages a team of subject matter experts and oversees coordination of new or changed regulatory summary development and distribution and implementation validation.
Serves as a leader, responsible for making decisions related to identifying and resolving complex technical and operational problems within the department, and could lead multiple managers or highly specialized professional associates.
Rethink routine to align team processes to add value and support of overall organizational goals or strategy and provide on-going oversight and monitoring of team performance to well defined metrics.
Identify process improvement opportunities based on data analysis and comprehensive risk assessment and scoring process.
Develop and oversee regulatory implementation validation and quality assurance process.
Work across departments and business segments to enhance reporting, trend analysis and operational improvement efforts.
Build relationships with aligned leaders and partners across the enterprise.
Responsible for making staffing decisions, training and overall performance of the team.
Development of consistent processes, procedures, and platform for an end-to-end regulatory process including intake, analysis, distribution, implementation and testing.
Defines metrics to track and report volume, timeliness, risks, and issues of distribution and implementation of new/changing regulations.
Development of post-implementation compliance assessment program to test controls and compliance with regulations.
Build a high-performance team that includes clear roles/responsibilities, training and a quality assurance program to monitor and improve team performance.
Use your skills to make an impact Required Qualifications Bachelor's Degree Claims, coding/billing, revenue cycle experience Advanced experience working in compliance, risk management, or managed-care field Strong communication skills with the ability to influence effectively Ability to exercise strong personal and professional judgment 2 or more years of management experience Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Leadership experience in Compliance, Risk Management or related areas, highly preferred MBA, Juris Doctor, or other graduate degree Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting.
The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$123,800 - $170,400 per year This job is eligible for a bonus incentive plan.
This incentive opportunity is based upon company and/or individual performance.
Description of Benefits Humana, Inc.
and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.
Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us Humana Inc.
(NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company.
Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.
These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran.
It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements.
This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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