DescriptionThe Senior Payment Integrity Professional 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 Senior Payment Integrity Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
Humana is seeking a Genetic Counselor to assist in the detecting and investigation of potential fraud and provide clinical guidance to the Special Investigators handling the cases. This is an inward facing role, with no direct member interaction. The daily assignment capsule includes reviewing of medical records for fraud, waste or abuse as well as review of Humana Medical Coverage Policies, CMS regulations, peer reviewed literature, and professional society’s publications for applicable regulations.
- Master’s Degree of Science in Genetic Counseling
- Active license in the state requiring licensure
- Proven successful experience in completing efficient health-related research, with associated analysis and conclusions
- Excellent organizational skills desired with ability to handle multiple tasks and deadlines with attention to detail
- Self-starter with the ability to work independently
- Excellent written and oral communication skills required
- Board Certified Genetic Counselor
- 3 -5 years or more of experience in genetic counseling or related role
- 3 or more years’ experience in the health industry, to include knowledge of CPT code billing.
- Experience with research, analysis and root cause identification
- Development of clinical and /or coding concepts and processes
- Proficiency with Excel
- Familiarity with CMS and/or Humana regulatory policies
At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.
Scheduled Weekly Hours40