Company name
Humana Inc.
Location
Indianapolis, IN, United States
Employment Type
Full-Time
Industry
Audit
Posted on
Sep 22, 2021
Profile
Description
Humana's Provider Payment Integrity organization is looking for a Senior Vendor Management Professional to join the Data Mining Vendor Management team! As the Senior Vendor Management Professional you will act as a liaison between business partners and the organization. You will make decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.
Responsibilities
As the Senior Vendor Management Professional you will review and negotiate terms of business partner contracts and communicate with business partners regarding day-to-day matters. You will build and maintain positive relationships with vendors and monitor vendor performance as well as research invoice and contractual issues and resolve discrepancies.
Core Responsibilities
Perform routine quality audits on PPI data mining partner concepts to determine payment accuracy, giving immediate feedback to assigned partner(s) as needed
Act as a liaison between internal areas and our PPI business partners
Lead business partner conference calls and meetings
Provide training when needed for PPI data mining business partners and other internal teams (i.e. audit team) involved with the AI program
Report/resolve security and system issues for external partners
Monitor partner quality and provide ad hoc reports as needed
Identify data trends, develop solutions to improve processes, and assist with presenting and implementing recommendations and solutions
Lead and provide solutions on any escalated disputes and subsequent clean-up efforts
Required Qualifications
Bachelor's degree or equivalent related work experience
3 years of medical claims auditing experience (interpreting if claims initially paid correctly in the system)
2 years Provider Payment Integrity (formally known as Financial Recovery) experience
CAS and MTV claims knowledge/experience
Intermediate knowledge/experience with Microsoft Excel
Ability to confidently communicate verbally and via email with external vendor partners
Demonstrated strong emotional intelligence
Strong relationship building skills
Work at Home/Remote Requirements
Must ensure designated work area is free from distractions during work hours and virtual meetings
Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required
Preferred Qualifications
Prior experience in a healthcare or medical insurance setting
Prior vendor relationship experience/knowledge
Prior AI experience/knowledge
Knowledge of Medicare Advantage
Certified Professional Coding
Scheduled Weekly Hours
40
Company info
Humana Inc.
Website : http://www.humana.com