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.
The Senior Payment Integrity Professional contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
• Experience in a customer facing role
• Contract interpretation experience
• Strong Research skills
• Minimum of Associates Degree
• Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
• Strong attention to detail
• Skilled in data and/or situational analysis
• Can work independently and determine appropriate courses of action
• Ability to handle multiple priorities
• Experience evaluating risk factor and implementing controls to mitigate risk
• Strong customer service skills and ability to explain detailed information
• Capacity to maintain confidentiality
• Excellent communication skills both written and verbal
• Must be located near a Humana facility for times needed to be in an office
• Ability to travel to either Green Bay, WI or Louisville, KY locations for a week for training initially
• Bachelor's Degree or higher
• Experience leading people, projects, and/or processes
• Experience in Provider Payment Integrity
• 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
• Provider Payment Integrity Customer Service
• Claims Coding knowledge
• Provider office experience
• Strong Research skills including CMS regulations
• Experience reading and interpreting claims
• Healthcare provider contract interpretation
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours40