Payment Integrity Professional 2 - Remote nationwide

Profile

Description

Responsibilities

The Payment Integrity Professional 2 contributes to overall cost reduction, by increasing the accuracy of provider payments in our payer systems, and by ensuring correct claims payment. This position will help analyze data to identify trends and driven decision making based on business needs and goals.

Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Required Qualifications

Experience maintaining dashboards using tools such as Power Bi, Tableau and Excel

Proven ability analyzing data to identify trends

Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel

Strong attention to detail, while handling multiple priorities and maintaining confidentiality

Can work independently and determine appropriate courses of action

Excellent communication skills both written and verbal

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

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.

Preferred Qualifications

Experience in Clinical Review

Experience in Financial Recovery

Experience using the following systems: CAS, MTV, CISpro and CIS

Knowledge of Microsoft Office Program Access and/or SQL or TOAD

Experience in a fast paced, metric driven operational setting

Bilingual in Spanish and English

Work at Home/Remote Requirements

Must ensure designated work area is free from distractions during work hours and virtual meetings

Must provide a high-speed DSL or cable modem for a workspace (Satellite, wireless and Hotspots are prohibited). A minimum standard speed of 25x10 (25mbs download x 10mbs upload) for optimal performance of is required

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com