Medical/Financial Risk Evaluation Professional
About The Position
The Medical/Financial Risk Evaluation Professional 2 is responsible for supporting the development, implementation and monitoring of medical/financial risk. The Medical/Financial Risk Evaluation Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical/Financial Risk Evaluation Professional 2 identifies, assesses, and mitigates any medical or financial risk that arises from inadequate or failed processes, people, systems, or external events. Maintains a balance between risk mitigation and efficiency. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Requirements
- Minimum of 2 years of medical claim billing or auditing experience
- Strong data analytics skills and experience in data extraction and analysis
- Demonstrated ability to perform effectively in a metric-driven environment
- Working knowledge of Microsoft Office Programs: PowerPoint, Access, OneNote and Excel
- Excellent written and verbal communication skills
- Meticulous attention to detail, with proven capability to manage multiple priorities simultaneously
- Able to work independently as well as collaboratively within a team, with minimal supervision
- Strong organizational and collaboration skills
- Effective time management skills, including the ability to multitask
Nice To Haves
- Bachelor's degree
- SQL experience
- CAS experience
- Prior experience with Humana financial recovery processes
- Certified Coder-American Academy of Professional Coders (AAPC)
- Prior experience leading projects or familiar with Six Sigma Methodology
- Prior experience reviewing and analyzing large amounts of claims data
- Knowledge of CMS and MA claims payment guidelines and processes
Responsibilities
- Supporting the development, implementation and monitoring of medical/financial risk.
- Identifying, assessing, and mitigating any medical or financial risk that arises from inadequate or failed processes, people, systems, or external events.
- Maintaining a balance between risk mitigation and efficiency.
- Understanding department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
- Making decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
- Following established guidelines/procedures.
Benefits
- Excellent professional development and continued education
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- Short-term and long-term disability
- Life insurance
- Competitive 401K match
- Generous Paid Time Off accrual
- Tuition Reimbursement
- Parental Leave
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
