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The healthcare consultant will perform the following responsibilities: Conduct analysis of health plan and provider functional areas to identify impacts, opportunities and risks related to the implementation of ICD-10, create high ..
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Description The Risk Adjustment Representative 2 conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other ..
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 Humana's recently created Clinical Resource Team is looking to grow the team with a Senior Nurse Auditor roles! This is a unique team that's primary role is to quickly jump ..
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 ..
... leads, fee schedule reimbursement, needed travel for in person dental office ... on continuously improving consumer experiences Travel is required for this role ... per week or as necessary...
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 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 ..
... physicians, physician groups, and integrated healthcare delivery systems throughout the country. ... delivery systems throughout the country. Healthcare isn't just about health anymore. ... of our members, and the..
Description The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an ..
Description Humana's Enterprise Clinical Management team needs your clinical, business and analytics acumen to solve for the healthcare challenges of today. The Clinical Analytics and Trend team uses advanced scientific techniques, ..
Description The Actuary, Analytics/Forecasting will develop the financial forecast for the dental and vision benefits included within Humana's growing Medicare Advantage business, as well as pricing and oversight of other stand ..
Description The Hospital Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Hospital Contracting Executive works on problems ..
Description Humana's recently created Clinical Resource Team is looking to grow the team with an Inpatient Senior Medical Coding Auditor roles! This is a unique team that's primary role is to ..
Description The Senior Health Information Management Professional ensures data integrity for claims errors. The Senior Health Information Management Professional work assignments involve moderately complex to complex issues where the analysis of ..
Description The Care Management Support Assistant 3 contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal ..
... moderate noise levels.The position requires travel between facilities and various locations ... various locations within the community. Travel to regional, divisional and corporate ... care provider is required.Ability to..
Description The Senior Clinical Business Professional is a clinical partner to the Commercial Product Strategy team. The Senior Clinical Business Professional work assignments involve moderately complex to complex issues where the ..
... degree Advanced degree in a healthcare-related field Knowledge of NCQA accreditation ... & Health Promotion Accreditation, Multicultural Healthcare Distinction, and/or LTSS Distinction Auditing ... at Home Nationwide with limited..
Description In order to make lasting, positive impact and change in the healthy equity of the communities we serve, leveraging the support of key stakeholders will be critical. As healthy equity ..
