Manager Fraud and Waste RN - WAH

Profile

Description

Seeking meaningful work? As a Fraud and Waste Manager at Humana, you will come to work every day with the knowledge that your work matters. The ideal candidate is a nurse coder with prior fraud experience, proven leadership ability and the ability to work from home. Compensation includes competitive salary, outstanding 401K match, generous PTO package and the potential for progressive career opportunities. Perfect for those passionate about the investigative process and eager to join a company that values individual contributions, places an emphasis on inclusion and diversity and promotes the ability to thrive as a community.

Responsibilities

What we need your help with:


Leads a team of 6 Senior Nurse Investigators in the day to day work of clinical investigations of alleged Fraud, Waste, and Abuse as well as 2 Data Analyst.
Partners with SIU in the triage and investigation process of all caseloads from identification to closure.
Assists with reporting clinical findings and recommendations.
Identifies and suggests process improvement opportunities.
Develops and monitors team goals, provides ongoing feedback and coaching, and conducts annual performance reviews.
Facilitates cross collaboration with internal resources to promote team work and empowerment to make informed decisions.


COME GROW WITH HUMANA! BENEFITS DAY ONE - STELLAR 401K MATCH - PAID TIME OFF -PROGRAMS - STELLAR WELLNESS/REWARDS PROGRAM

What you need for success! - Required Qualifications


Bachelor's Degree in health or business related field. Equivalent years of experience in a similar role will be accepted.
Active Registered Nurse (RN) license and Certified Professional Coder (CPC)
3 years of experience healthcare experience within a fraud investigations or auditing role
2 years of leadership and/or progressive business consulting experience
Prior experience with medical coding as well as solid knowledge of healthcare payment methodologies
Prior experience leading meetings and presenting material to broad audiences


Work at Home Requirements


Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.


What you need to be STAND OUT among the crowd! : Preferred Qualifications


Familiarity with CMS and Humana regulatory policies
Prior health insurance claims experience
Prior experience managing Financial Recovery
Prior experience working within a fast paced, metric driven operational setting


Scheduled Weekly Hours

40

Company info

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