Payment Integrity Professional 2 - Work at Home Nationwide

Profile

Description

The Payment Integrity Professional 2 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 Payment Integrity Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Payment Integrity Professional 2 will focus on preventing unnecessary payments to providers and recovering overpayments when they happen. You will complete analyses and prepare disclosure materials while interacting and building partnerships with Humana's code editing, communications, and information technology teams and with external vendors. Responsibilities will include: research, document, and analyze multi-faceted data with statistical, financial, and clinical emphases. Follows established guidelines/procedures.


Identify data trends, develop programs to solve problems, and assist in presenting and implementing recommendations and solutions.
Act as a liaison with specific vendors, including managing the relationship, auditing and analyzing their data, making recommendations for improvement, and providing updates to management
Assist with Monthly and weekly inventory reports
Assist with Escalated Projects and requests from other Humana departments.
Act as a liaison between multiple business partners to identify and resolve problems and concerns
Make recommendations regarding the accuracy of claim payments and process improvements


Required Qualifications


High school diploma or equivalent
1 year of data interpretation, analysis or related experience
Proficient knowledge of Microsoft Excel (formatting, pivot tables, formulas, graphs, vlookup)
Strong attention to detail
Experience planning and facilitating effective meetings
Can work independently and determine appropriate courses of action
Strong Collaboration skills
Possess self-drive and strong initiative
Strong Organizational skills
Demonstrated ability to handle multiple tasks and deadlines with attention to detail, while maintaining an agile approach to an ever-changing environment
Ability to travel to Louisville, KY once a year


Preferred Qualifications


Billing and/or claims processing experience
Demonstrated project management experience
At least 1 year experience with medical claim payments/processing
Associates or Bachelor's Degree of Art or Science
Claims processing or financial recovery experience using CAS or MTV
Knowing how to build complex queries in Microsoft Access/TOAD


Additional Information for Work at Home


Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.
Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M


Scheduled Weekly Hours

40

Company info

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