Payment Integrity Professional 2 CCM Remote

Profile

Description

Humana's Provider Payment Integrity organization is looking for Payment Integrity Professional 2 with claims experience to join the Claims Cost Management (CCM) Solutions Support team working from home anywhere in the US. This dedicated team is focused on building data-driven analytical solutions to prevent fraudulent claims. On this team, the Payment Integrity Professional 2 will contribute to overall cost reduction by increasing the accuracy of provider contract payments in our payer systems and by ensuring correct claims payment.

Responsibilities

As the Payment Integrity Professional 2, you will use technology and data mining, detects anomalies in data to identify and collect overpayment of claims. In this role, you may utilize the following applications: Excel, Access, PowerPoint, CAS, MetaVance, CGX, CIS, CDR, CIS PRO, eHUB

Key Role Functions


Validate and build complex rules in THOR
Provide expertise on the appropriate processing of complex claims concepts
Lead and organize meetings
Develop THOR build solutions for outside areas


Required Qualifications


Bachelor's Degree or equivalent related work experience
2 years of experience reading and interpreting claims
Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
Strong attention to detail
Ability to work independently and determine appropriate courses of action
Ability to handle multiple priorities
Capacity to maintain confidentiality
Excellent communication skills both written and verbal
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


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 and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required


Preferred Qualifications


Experience leading people, projects, 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


Scheduled Weekly Hours

40

Company info

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