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Provider Payment Integrity Analyst - RN Clinical Auditor - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Louisville, KY Louisville, Kentucky |
About this job
Role: Provider Payment Integrity Analyst - RN Clinical Auditor
Assignment: Provider Payment Integrity
Location: Work at Home
We're looking for associates who are dedicated to service and believe in following the Golden Rule of treating others the way you want to be treated. Humana was founded on this premise, and this value is reflected in our expectations for providing perfect service to our consumers, providers, employers, agents and others we work with. At Humana, Perfect Service means getting the basics done right, delivering value and quality, and providing everyone with personalized attention and guidance. We want to engage with our members through every step of their journey to lifelong well-being. This includes meaningful direct consumer interaction and developing positive relationships with healthcare providers. Humana associates provide Perfect Service every day to our members, employers, providers, and colleagues. We're looking for people who improve their own well-being by looking out for the best interests of others
Assignment Capsule
Be a part of the Provider Network world -- collaborate cross functionally to identify process opportunities to improve the provider experience
Humana is seeking an individual to focus on preventing unnecessary payments to providers and recovering overpayments when they happen.
Perform routine and special audits of par and no-par provider claims
Make recommendations regarding the accuracy of claim payments and process improvements
Review and audit claims that match the query criteria
Key Competencies
Accountability : Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
Builds Trust : Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.
Collaborates : Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana's overall success first.
Pursues Excellence : Seeks out learning, strives to develop and expand personally, and continuously helps others upgrade their capability to contribute to Humana.
Role Essentials
RN Associates Degree in Nursing
Active CPC license or willingness to acquire CPC license within 1 year of role acceptance
Comprehensive knowledge of Microsoft Word and Excel
3-5 years' experience in Nursing
Prior auditing experience
Excellent communication skills both written and verbal
Ability to work well with ambiguity and in a non-structured environment
Ability to work independently and apply critical thinking, with area of specialty knowledge, to the audits
Role Desirables
Bachelor's Degree in Nursing (BSN) preferred
ICD-10 certification
Prior experience with ICD-9/ICD-10
Familiar with Health Carrier Medical Coverage Policies, CMS NCD's, LCD's
Knowledge of CMS, Medicare and Commercial regulations
Reporting Relationships
You will report to a manager. This area is under the leadership of the SVP & Chief Operating Officer.
Additional Information
Humana is an organization with careers that change lives---including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Apply now, or join our Talent Network so you can stay informed and up to date on what's happening at Humana.
Assignment: Provider Payment Integrity
Location: Work at Home
We're looking for associates who are dedicated to service and believe in following the Golden Rule of treating others the way you want to be treated. Humana was founded on this premise, and this value is reflected in our expectations for providing perfect service to our consumers, providers, employers, agents and others we work with. At Humana, Perfect Service means getting the basics done right, delivering value and quality, and providing everyone with personalized attention and guidance. We want to engage with our members through every step of their journey to lifelong well-being. This includes meaningful direct consumer interaction and developing positive relationships with healthcare providers. Humana associates provide Perfect Service every day to our members, employers, providers, and colleagues. We're looking for people who improve their own well-being by looking out for the best interests of others
Assignment Capsule
Be a part of the Provider Network world -- collaborate cross functionally to identify process opportunities to improve the provider experience
Humana is seeking an individual to focus on preventing unnecessary payments to providers and recovering overpayments when they happen.
Perform routine and special audits of par and no-par provider claims
Make recommendations regarding the accuracy of claim payments and process improvements
Review and audit claims that match the query criteria
Key Competencies
Accountability : Meets established expectations and takes responsibility for achieving results; encourages others to do the same.
Builds Trust : Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions.
Collaborates : Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana's overall success first.
Pursues Excellence : Seeks out learning, strives to develop and expand personally, and continuously helps others upgrade their capability to contribute to Humana.
Role Essentials
RN Associates Degree in Nursing
Active CPC license or willingness to acquire CPC license within 1 year of role acceptance
Comprehensive knowledge of Microsoft Word and Excel
3-5 years' experience in Nursing
Prior auditing experience
Excellent communication skills both written and verbal
Ability to work well with ambiguity and in a non-structured environment
Ability to work independently and apply critical thinking, with area of specialty knowledge, to the audits
Role Desirables
Bachelor's Degree in Nursing (BSN) preferred
ICD-10 certification
Prior experience with ICD-9/ICD-10
Familiar with Health Carrier Medical Coverage Policies, CMS NCD's, LCD's
Knowledge of CMS, Medicare and Commercial regulations
Reporting Relationships
You will report to a manager. This area is under the leadership of the SVP & Chief Operating Officer.
Additional Information
Humana is an organization with careers that change lives---including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you're ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.
Apply now, or join our Talent Network so you can stay informed and up to date on what's happening at Humana.