Medical/Financial Risk Evaluation Professional 2- Remote nationwide

Profile

Description

The Medical/Financial Risk Evaluation Professional 2 is responsible for supporting the development, implementation and monitoring of medical/financial risk, and mitigates any medical or financial risk that arises from inadequate or failed processes, people, systems, or external events. In this position, you will work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

Job Description

The hours are Mon-Fri providing coverage 6am-6pm EST with 8 hour flexible shifts to be determined.

Required Qualifications

Current Coding Certification with AAPC or AHIMA

Basic knowledge of CAS/MTV

Data analysis using Excel

Experience creating and presenting information to diverse audiences including senior leaders

Comfortable working in self-directed self-motivated environment

Work at Home/Remote Requirements

Must ensure designated work area is free from distractions during work hours and virtual meetings

Must provide a high-speed DSL or cable modem for a workspace (Satellite, wireless and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

Background or knowledge of code edit processes - strongly preferred

Bachelor's degree or 5 years of Health Plan experience

Minimum 3 years experience with claims process **or correct coding

Demonstrated process development experience

Experience implementing claims payment edits or audits

Experience with relational databases (access or SQL) * optional

Adaptable to change

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com