Humana

About Humana

 

Job Category:

Analytics & Business Intelligence - Business Intelligence & Reporting

Country:

United States

Postal Code:

40201

Approximate Salary:

Not Specified

Position Type:

Full Time

Data and Reporting Professional 2

Humana - Louisville, Kentucky

Posted: 09/5/2018

Description

The Data and Reporting Professional 2 generates reports and or report information using system tools and database or data warehouse queries and scripts. The Data and Reporting Professional 2 work assignments are related to Provider Payment Integrity and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Humana is seeking an individual to focus on preventing unnecessary payments to providers and recovering overpayments when they happen.

  • Make recommendations regarding the accuracy of claims data and process improvements
  • Utilize Excel and SQL to facilitate conducive data research for improved claims selections
  • Review and analyze specified audit programs that match the established scoring models
  • Collaborate with internal Clinical/Coding professionals to discuss relevant audit rate movements  
  • Identify potential cost-saving adjustments to query logic and communicate changes with CCRO (Claims Cost & Research Opportunity) department
  • Monitor industry influencing ideas and regulation changes impacting audit programs
  • Proactive in deciphering variances between external vendor and internal audit programs hit rate

               

Required Qualifications

  • Associates degree
  • Less than 5 years of technical experience in data reporting
  • Comprehensive knowledge of Microsoft Office Applications including Word, Excel, Access and PowerPoint
  • 1+ years of experience in SQL, SAS, QlikView and Tableau
  • Experience creating automated reports and self-service tools
  • In-depth experience in Microsoft Excel including formulas, pivots, charts, and graphs
  • Excellent organizational skills

Preferred Qualifications

  • Advanced Degree in a quantitative discipline, such as Mathematics, Economics, Finance, Statistics, Computer Science, Engineering or related field
  • Claims processing (CAS, MTV)
  • Experience in managed care or health care sector
  • Prior experience working in a system analytics and/or data warehousing environment

Additional Information

Scheduled Weekly Hours

40

Apply Now