Associate Director of Clinical Audit Payment Integrity - REMOTE in US

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Job Information
Humana
Associate Director of Clinical Audit, Payment Integrity - REMOTE in US
in
Troy
Michigan
Description
The Associate Director of Clinical Audit, Payment Integrity uses their clinical experience and knowledge to connect the technology and data, and to detect anomalies in data to identify and collect overpayment of claims. They will contribute to the investigations of fraud waste and abuse to support our financial recovery. This position requires a solid understanding of how organization capabilities interrelate across department(s).
Responsibilities
The Associate Director of Clinical Audit, Payment Integrity contributes to overall cost reduction, by increasing the accuracy of provider payments in our payer systems, and by ensuring correct claims payment. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates. Well rounded experience and grasp of business acumen.
Required Qualifications
Registered Nurse - with 2 yrs Clinical work experience
6 or more years of work experience related to claims/claims payment/chart review
2 or more years of management experience in the payer environment
Experience with inventory management, budgeting, staffing models
Able to determine the needed approach, resources, and goals to meet business objectives
Demonstrated experience with cross departmental collaboration
Experienced facilitating, consulting, and delivering complex concepts
Advanced proficiency with Microsoft Office Programs Word, PowerPoint, and Excel
Agile mindset and ability to handle multiple priorities
Capacity to maintain confidentiality
Excellent communication skills both written and verbal
This is a Work from home position that will require possibility of travel up to 25%
If progressed to offer, you will be required to:
Provide proof of full vaccination, including booster,
or commit to testing protocols OR
Provide proof of applicable exemption including any required supporting documentation
​​Medical, religious, state and remote-only work exemptions are available.
Preferred Qualifications
Bachelor's Degree
Coding Certification through AHIMA or AAPC (i.e. - CCS, CPC)
Experience leading projects and processes
Experience in Financial Recovery
Experience with multiple payer systems
Knowledge of Microsoft Office Programs Access and Project
Project Management Professional (PMP) Certification
Bilingual in Spanish and English
Additional Information
Work-At-Home Requirements
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Montage/Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a SMS Text Messaging interview. You will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
#LI-Remote
Scheduled Weekly Hours
40

Company info

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