Senior Payment Integrity Professional-Remote US

Description

The Senior Payment Integrity Professional uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our financial recovery. The Senior Payment Integrity Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Responsibilities

Where you Come In

The Senior Payment Integrity Professional contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

What Humana Offers

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Required Qualifications - What it takes to Succeed

• Current Registered Nurse
• Minimum of 1 year work experience reading and interpreting claims
• Minimum of 2 years broad clinical experience
• Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
• Strong attention to detail
• Skilled in data and/or situational analysis
• Can work independently and determine appropriate courses of action
• Ability to handle multiple priorities
• Capacity to maintain confidentiality
• Excellent communication skills both written and verbal
• Core business hours align to Eastern Standard Time (EST)
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

According to Humana's COVID-19 policy, vaccination and masking is required regardless of vaccination status (with exception for eating and drinking) for associates working in a clinical setting where patients receive care (e.g., pharmacy retail locations, clinics, home care). The policy only requires the primary series alone (first and second vaccine). Boosters are encouraged, but not required. Associates have the option to request an accommodation for medical, religious or other personal needs.

Preferred Qualifications

• CPC (Certified Professional Coder) Certificate
• Familiarity with CMS and Humana regulatory policies
• Experience in CCM (Claims Cost Management)
• Experience leading people, projects, and/or processes
• Experience in a fast paced, metric driven operational setting
• Bilingual in Spanish and English

Additional Information - How we Value You• Benefits starting day 1 of employment • Competitive 401k match • Generous Paid Time Off accrual • Tuition Reimbursement • Parent Leave • Go365 perks for well-being

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone or text and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40