M.D.S. Minimum Data Set Nurse Analyst

Role: Nurse Analyst -- MDS

Assignment: Provider Payment Integrity Analyst

Location: Louisville, KY

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 to determine payment accuracy

Make recommendations regarding

the accuracy of claim payments and process improvements

Utilize Excel and Access to launch

theoretical claim queries into the system

Review and audit claims that

match the query

Contact providers to discuss

overpayments and arrange recovery

Role Essentials

RN or LPN

with a minimum of 2 years of experience in Skilled Nursing Facility

2 or more

years of experience with Long Term

Health Care MDS (Minimum Data Set) Assessment

Experience

with RUG (Resource Utilization Group) IV and RUG III Medicare

reimbursement systems

Experience

with the billing of RUGs i.e. HIPPS codes, Days of billing for each

assessment type

Experience

with MDS coding rules for the MDS 3.0, particularly related to ADL coding

and Therapy minutes coding

Excellent

verbal, written and oral communication skills

Detail

oriented

Role Desirables

* Bachelor

of Science degree in Nursing

* Certified

Resident Assessment Coordinator (RAC -CT) preferred

* Familiarity

with UB claim form preferred

* Previous

RUG auditing experience preferred

* Experience

with Microsoft office (Excel , Access, PPT, and Word)

* CPC

certification

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.