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Description The Senior Claims Research & Resolution Professional manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claims issues/complaints within contractual ..
Description Humana Healthy Horizons in Florida is seeking a STARS Improvement Professional 2 who will develop, implement, and manage oversight of the company's Medicaid Stars Program. They will direct all quality ..
Job Information Humana Staff RX Clinical Programs Oncology Pharmacist in Springfield Missouri Description The Staff RX Clinical Programs Oncology Pharmacist will be responsible for building relationships with oncology clinical practices that ..
... looking for an experienced Senior Healthcare Investigator to join its industry ... provider records ensuring appropriateness of billing practices. Prepares complex investigative and ... Qualifications Bachelor's degree or significant..
Job Information Humana Call Center Pharmacy Claims Technician, Remote in Springfield Missouri Description The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative ..
Description The Coding Educator 2 identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. The Coding Educator 2 work assignments are varied and frequently ..
Description Assist local pharmacies with claims adjudication to support medication access for HC & LTC hospice patients; reconcile historic billing issues. Responsibilities There are 4 shifts available for this role. All ..
Job Information Humana Manager, Fraud and Waste-Remote US in Springfield Missouri Description The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste ..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. The ..
... medical record documentation for incorrect billing and coding. The ideal candidate ... ensure capture of all relevant billing discrepancies. Identifies the root cause ... reviews of provider codes and..
Job Information Humana Nurse Auditor 2/ER - WFH/REMOTE-- Anywhere in the US in Springfield Missouri Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and ..
... Options Search Career Opportunities Hire Healthcare Professionals Pay My Bill Find ... Homecare Springfield, MO, 65802 Homecare, Healthcare Contract - Full Time I'm ... Full Time I'm Interested Maxim..
Description The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement. Responsibilities ..
... is looking for an experienced Healthcare Investigator to join its industry ... provider records ensuring appropriateness of billing practices. Prepares investigative and audit ... areas Bachelor's degree or significant..
... Options Search Career Opportunities Hire Healthcare Professionals Pay My Bill Find ... Homecare Springfield, MO, 65804 Homecare, Healthcare Contract - Full Time I'm ... Full Time I'm Interested Maxim..
Job Information Humana Associate Director, Site Reliability Engineering in Springfield Missouri Description The Associate Director, Site Reliability Engineering maintains, integrates and implements software applications within the organization. The Associate Director, Site ..
Description The Nurse Auditor 2 will work on the clinical research and development team with coders, clinicians and genetic counselors to develop, implement and maintain clinical lab audit concepts. The Nurse ..
Job Information Humana Genetic Counselor (Board Certified)-Remote/Virtual in US in Springfield Missouri Description Humana is seeking a Board Certified Genetic Counselor to join our Special Investigations Unit - Clinical Review team ..
Description Be a part of an interactive team with broad exposure and scope within Humana. Humana is seeking a positive and proactive individual to contribute to a high performing team that ..
