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Job Information Humana Healthcare Data Analyst in Louisville Kentucky Description The Payment Integrity Professional 2 uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. ..
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... Required Qualifications Bachelor's Degree in healthcare administration, management, or business. or ... of experience handling tasks related healthcare / medical claims 2 years ... Preferred Qualifications Master degree in..
Description The Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder for Humana's Kentucky Medicaid ..
Description The Quality Compliance Nurse (RN) Professional uses quality improvement methodology to analyze data and works collaboratively with teams to improve quality for KY Medicaid members. How We Value You Benefits ..
Description The Care Coach 1 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the ..
Description The Provider Contracting Professional 2 initiates, negotiates, and executes dental provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Professional 2 work assignments are varied ..
Description The Financial Analytics Professional 2 manages data to support and influence decisions on day-to-day operations, strategic planning and specific business performance issues. The Financial Analytics Professional 2 work assignments are ..
... Pharmacist, Registered Nurse, other licensed healthcare professional 3 years of experience ... years of experience working on healthcare quality and performance measure improvement ... Qualifications Bachelor's degree in Business,..
Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM and PCS) to patient records. The Medical ..
... techniques Understand what top Physician/APP talent looks like and know how ... know how to propel the talent within Care Delivery Organization Execute ... Care Delivery Organization Execute Humana's..
Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization ..
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 ..
Description The Medicaid Quality Improvement Coordinator implements and participates in quality improvement (QI) activities for the Kentucky Medicaid Early Periodic Screening Diagnosis and Treatment (EPSDT) team. This includes, but is not ..
... Qualifications Bachelor's degree in Business, Healthcare, or related field Certified Professional ... related field Certified Professional in Healthcare Quality (CPHQ) Experience with quality ... plan-do-study-act Advanced degree in business,..
Description The Senior Application Architect designs and develops IT applications and architects solutions to business problems in alignment with the enterprise architecture direction and standards. The Senior Application Architect work assignments ..
Description The Senior Value-Based Financial Analyst supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Senior Value-Based Programs Professional works on problems ..
Description The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse. The Compliance Nurse ..
Description The Payment Integrity Professional 2 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 ..
... 41) market leader in integrated healthcare with a clearly defined purpose ... we are seeking an experienced healthcare leader to join our team ... President, Strategy Advancement for our..
Description The Medical Coding Auditor reviews medical records to verify coding (ICD-10 CM/PCS). The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate ..
Description The Senior Value-Based Programs Analyst supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Senior Value-Based Programs Analyst works on problems ..
