Code Edit Professional, Payment Integrity

Humana

8d • $65,000 - $88,600 • Remote

About The Position

The Payment Integrity Professional 2 utilizes vendor platforms, claims processing platforms, and data to collaborate with key internal and external business stakeholders, while supporting claims code editing pre and post-implementation and functionality. The opportunity contributes to the overall goal of claims cost reduction and is available for WAH nationwide.

Requirements

• Experience with forward-facing client and/or vendor relationship management
• Experience facilitating meetings with internal and/or external stakeholders
• Data analysis and/or research experience
• Proficient in managing diverse priorities, adept at swiftly transitioning between tasks based on urgency and demand
• Comfortable navigating and making decisions in a dynamic and everchanging environment
• Working knowledge of Microsoft Office Programs Word, SharePoint, and Excel
• Problem-solving abilities, including thinking outside the box and collaborating with others to achieve optimal outcomes
• Ability to work both independently and within a team structure, with minimal supervision
• Analytical Thinking/Problem-solving abilities, including thinking outside the box and collaborating with others to achieve optimal outcomes
• Strong attention to detail
• Proficiency in verbal/written communication
• Ability to operate in a fast paced, agile, metric driven operational setting
• Commitment to upholding ethical standards and professional integrity in all interactions, including ability to maintain confidentiality
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Nice To Haves

• Prior experience utilizing code edit vendor tools
• Advanced Excel knowledge (H-lookups, V-lookups, pivot tables, etc)
• Prior experience working with external vendors and/or internal stakeholders
• Prior experience with Humana code edit claims processes
• Working knowledge of Microsoft Office Programs: PowerPoint and OneNote
• Prior experience in THOR Rule creation and/or processes
• Prior experience leading projects, and/or processes
• Prior experience analyzing medical claims data

Responsibilities

• Foster relationships between Code Edit Management, internal stakeholders and multiple external code editing vendors
• Support of new code edit reviews, testing, implementation and maintenance management
• Management and resolution of code edit stakeholder inquiries
• Drive process improvements and ensure successful run of business

Benefits

• medical
• dental
• vision
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed