Humana

About Humana

 

Job Category:

Consumer Service Operations - Provider Payments

Country:

United States

Postal Code:

40201

Approximate Salary:

Not Specified

Position Type:

Full time

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Payment Integrity Lead

Humana - Louisville, Kentucky

Posted: 07/4/2018

Description

The Payment Integrity Lead 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 Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Payment Integrity Lead contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

               

Required Qualifications

  • Bachelor's Degree or higher
  • 8+ years' work experience reading and interpreting claims
  • 2+ years of project leadership experience
  • Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
  • Skilled in data and/or situational analysis
  • Excellent independent judgement and decision making ability for complex issues
  • Ability to handle multiple priorities
  • Capacity to maintain confidentiality
  • Excellent communication skills both written and verbal

Preferred Qualifications

  • Experience leading people and/or processes
  • Experience in Financial Recovery
  • Experience using the following systems: CAS, MTV, CISpro and CIS
  • Knowledge of Microsoft Office Programs Access and Project
  • Experience in a fast paced, metric driven operational setting
  • Project Management Professional (PMP) Certification
  • Bilingual in Spanish and English

Additional Information

Scheduled Weekly Hours

40

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