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.
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.
Required Qualifications: Bachelor's Degree Minimum of 5 years' work experience reading and interpreting claims Experience leading projects, and/or processes 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
Additional Requirements: Hours: 8 hour schedule available between 6:00 AM - 5 PM Local TimeIf Approved Remote/WAH: Must have a separate room with a locked door that can be used as a home office to ensure you and your patients have absolute and continuous privacy while you workMust have accessibility to hardwired high speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited)
Preferred Qualifications: Experience in Financial Recovery and Pre-Pay audit Experience using the following systems: CAS, MTV, CISpro and CIS Knowledge of Microsoft Office Programs Access and Project Experience in a fast paced, metric driven operational setting
Additional InformationInterview Format As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice 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 Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone 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
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms -when and where they need it. Our employees are at the heart of making this happen and that's why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
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