Senior Payment Integrity Professional-Louisville, KY/Waterside or WAH but must be near a Humana offi

The Senior Payment Integrity Professional uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our financial recovery. The Senior Payment Integrity Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Payment Integrity Professional contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
Required Qualifications
Experience in a customer facing role
Contract interpretation experience
Strong Research skills
Minimum of Associates Degree
Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
Strong attention to detail
Skilled in data and/or situational analysis
Can work independently and determine appropriate courses of action
Ability to handle multiple priorities
Experience evaluating risk factor and implementing controls to mitigate risk
Strong customer service skills and ability to explain detailed information
Capacity to maintain confidentiality
Excellent communication skills both written and verbal
Must be located near a Humana facility for times needed to be in an office
Ability to travel to either Green Bay, WI or Louisville, KY locations for a week for training initially
Preferred Qualifications
Bachelor's Degree or higher
Experience leading people, projects, and/or processes
Experience in Provider Payment Integrity
Experience using the following systems: CAS, MTV, CISpro and CIS
Knowledge of Microsoft Office Programs Access and Project
Experience in a fast paced, metric driven operational setting
Provider Payment Integrity Customer Service
Claims Coding knowledge
Provider office experience
Strong Research skills including CMS regulations
Experience reading and interpreting claims
Healthcare provider contract interpretation
Additional Information
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours

Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.