Become a part of our caring community and help us put health first
The Medical/Financial Risk Evaluation Professional 2 is responsible for supporting the development, implementation and monitoring of medical/financial risk.
The Medical/Financial Risk Evaluation Professional
* Identifies, assesses, and mitigates any medical or financial risk that arises from inadequate or failed processes, people, systems, or external events.
* Maintains a balance between risk mitigation and efficiency
* Develop reporting to identify patterns and trends
* May create specifications for reports based on business requests and understanding of needs and changes to operational processes
Use your skills to make an impact
Required Qualifications
* Comprehensive experience Microsoft Word, Excel (pivot tables, formulas, data manipulation), PowerPoint, Visio and Access (data analysis, experience with relational databases)
* 2 or more years of experience with CMS and/or AHCA compliance
* 2 or more years Claims experience
* 2 or more years Audit and/or Financial Recovery experience
* SQL skills/knowledge and ability to build code to query databases (SQL Server, Oracle, etc.) and understanding database structure and design
Preferred Qualifications
* Direct experience working with Medicare claims
* Working knowledge of CPT, ICD10 and HCPC
* Provider contract experience
* Experience with tools such as SAS, Power BI, SSIS, Power Apps, Power Automate, Tableau, and/or Qlikview for running analysis, automating processes, or creating dashboards, self-service tools, and data visualizations
Additional Information
5% travel
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Work at Home Guidance
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
* At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
* Satellite, cellular and microwave connection can be used only if approved by leadership
* Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
* (COMPANY NAME) will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
* Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/yammer and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
Alert: (COMPANY NAME) values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from (COMPANY NAME)@myworkday.com with instructions on how to add the information into your official application on (COMPANY NAME)'s secure website.
#LI-BB1
#LI-Remote
Scheduled Weekly Hours
40
Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$57,700 - $79,500 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, "(COMPANY NAME)") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, (COMPANY NAME) provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of (COMPANY NAME), CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.
About (COMPANY NAME): (COMPANY NAME) Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our (COMPANY NAME) insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of (COMPANY NAME) not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of (COMPANY NAME) to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment
