Associate Director of Documentation and Inpatient Coding Payment Integrity - REMOTE US

Profile

Description

The Associate Director, Payment Integrity 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 Associate Director, Payment Integrity requires a solid understanding of how organization capabilities interrelate across department(s).

Responsibilities

The Associate Director, Payment Integrity contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s), and could lead multiple managers or highly specialized professional associates.

Required Qualifications

Minimum 2 years Inpatient Coding Certification through AHIMA or AAPC

6 or more years of work experience related to claims/claims payment/chart review

3 or more years experience reviewing and working with inpatient claims

2 or more years of management experience leading multiple teams with different priorities

Able to determine the needed approach, resources, and goals to meet business objectives

Demonstrated experience with cross departmental collaboration

Experienced facilitating, consulting, and delivering complex concepts

Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel

Ability to handle multiple priorities

Capacity to maintain confidentiality

Excellent communication skills both written and verbal

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Bachelor's Degree

CCS/RHIT/RHIA

Experience leading projects and processes

Experience in Financial Recovery

Experience with the CAS and/or MTV systems

Knowledge of Microsoft Office Programs Access and Project

Project Management Professional (PMP) Certification

Bilingual in Spanish and English

Additional Information

Work-At-Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

#LI-Remote

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com