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Humana Payment Integrity Professional 2/RN - Remote in US in Albany, New York


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 financial recovery. The Payment Integrity Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.


Where you Come In

Humana is looking for an experienced certified Home Health Care Registered Nurse to assist with provider dispute resolution. In this position you will be working from home in a fast paced environment collectively with a team of certified coders to review and resolve provider claim payment disputes. Actively contributes to meeting department goals and priorities through the performance of root cause analysis of identified trends along with tracking/trending of results and works with our customers to reach satisfactory outcomes.

  • Work on disputes

  • Assist with trending results

What Humana Offers

We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education.

Required Qualifications - What it takes to Succeed

  • Must have current US RN license, in the state of residence without any restrictions

  • Minimum 3 years of clinical experience within Home Health field

  • At least one of the following Certifications: Home Health- certified OASIS coder- HCS-O, HCS-D, COS-C

  • Minimum of 1 years' work experience, reading and interpreting claims, performing coding quality audits in a health insurance and/or clinical setting; and working disputes and trending results

  • Comprehensive understanding of all related Home Health guidelines including coding, billing and CMS regulations

  • Able to apply analytical and critical thinking to Home Health record reviews

  • Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel

  • Strong attention to detail

  • Can work independently and determine appropriate courses of action

  • Ability to handle multiple priorities

  • Capacity to maintain confidentiality

  • Excellent communication skills both written and verbal

Preferred Qualifications

  • 5 years of auditing experience in Home Health.

  • Certified Professional Coder (CPC)

  • Bachelor's Degree

  • Experience in Financial Recovery

  • Experience in a fast paced, metric driven operational setting

Additional Information - How we Value You

  • Benefits starting day 1 of employment

  • Competitive 401k match

  • Generous Paid Time Off accrual

  • Tuition Reimbursement

  • Parent Leave

  • Go365 perks for well-being

  • Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.

  • Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire 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 Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone or text 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.

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours