Become a part of our caring community and help us put health first The Payment Integrity Professional 2 for the Special Investigations Unit (SIU) Medicaid Team helps make sure compliance and program integrity are top priorities across all Medicaid Lines of Business (LOB). The role ensures compliance with contractual, statutory, and governmental reporting requirements for SIU. The work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Payment Integrity Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
What You'll Do:
Lead a team focused on Medicaid program integrity reporting for SIU
Research and suggest process improvements
Collect, analyze, and interpret data for regular and ad hoc reporting
Respond to SIU leadership's requests for data and insights
Keep communication flowing between the Resolution Team - Compliance Research & Reporting and SIU teams
Use reporting tools and software (Excel, PowerPoint, etc.) to present findings
SME for the implementation of required reporting related to SIU.
Use your skills to make an impact
WORK STYLE: Remote, work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day and 5 days/week. Associates are expected to align their work hours to EST or CST, regardless of their home time zone.
Required Qualifications
Experience in compliance reporting, Medicaid reporting, and/or SIU support
Claims experience
Good attention to detail, especially for contracts and reports
Proficient with Microsoft Office (Excel, Word, PowerPoint)
Ability to juggle multiple priorities and meet deadlines
Strong communication and teamwork skills
Can work independently and determine appropriate courses of action
Capacity to maintain confidentiality
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Bachelor's or advanced degree
Audit, consulting, and/or compliance background
Knowledge of Department of Insurance, CMS, and Medicaid contracts
Experience with healthcare fraud investigations or SIU work
Familiarity with Power BI and SQL
Additional Information
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.
About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Requisition #: R-395582
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