Job Description

Description

Humana Healthy Horizons in Indiana is seeking Provider Claims Educators (Medicaid) who will be responsible for: conducting root cause analyses of claims data to track and trend claims denials or rework, underpayments, and claims errors. They will engage with providers, one-on-one or in group settings, to educate them on appropriate claims submission processes and requirements, coding updates, and common billing errors in order to reduce claims denials and assists providers in getting reimbursed timely and accurately. The Provider Claims Educators (Medicaid) work assignments that are varied and frequently require interpretation and independent determination of the appropriate courses of action. They understand department, segment, and organizational strategy and operating objectives, including their applications to assignments. They follow general guidance and processes and must use independent judgement to execute effectively on assigned work.

Responsibilities

• Routinely tracks and trends provider claims denials and rework to determine root cause.
• Conducts training with providers or groups of providers and their staff on claims denials, rework, and/or underpayments based on trended provider claims issues and common claims errors.
• Escalates any trended claims issues stemming from internal systems issues to Provider Claims Manager and assist in development of solutions to resolve those issues within our claims processing systems.
• Convenes billing forums with selected provider associations where providers can ask billing questions and/or receive guidance.
• Monitors providers post-training to ensure the issues causing the denials are resolved.
• Partners with Provider Relations Representatives to ensure prompt resolution of provider inquiries, concerns, or problems associated with claims payment.
• Assists with development of provider bulletins or training documents related to common claims issues and billing inaccuracies.
• Works with internal corporate partners to ensure cross-department communication and resolution of provider’s issues.

Required Qualifications

• Must reside in the state of Indiana.
• Must be able to travel in the state of Indiana to provider offices and Humana locations.
• Two (2) or more years of health insurance claims experience, such as claims education, claims processing.
• Experience working for or with key provider types (primary care, FQHCs, hospitals, nursing facilities, and/ Long Term Services and Supports (LTSS) and Home and Community Based Services (HCBS) providers).
• Experience analyzing data to track and trend common claims issues.
• Exceptional time management and ability to manage multiple priorities in a fast-paced environment.
• Knowledge of Microsoft Office applications.
• This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.
• This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Preferred Qualifications

• Bachelor's degree.
• Experience with Indiana Medicaid.
• Thorough understanding of managed care contracts, including contract language and reimbursement.
• Experience with claims systems, adjudication, submission processes, coding, and/or dispute resolution.

Work at Home Requirements

• 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.
• Humana 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.

Additional Information:

• Workstyle: Remote but may vary due to travel and occasional onsite work at the Humana Healthy Horizons office in Indiana.
• Travel: Up to 25% travel in the state of Indiana to provider offices and Humana locations.
• Core Workdays & Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes; 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more…..

Job Type: Full-time

Pay: $63,000.00 - $66,000.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Paid training
• Professional development assistance
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift

Supplemental pay types:

• Bonus pay

Experience:

• health insurance claims education and processing.: 2 years (Required)
• / Long Term Services and Supports (LTSS): 1 year (Required)
• Home and Community Based Services (HCBS): 1 year (Required)
• analyzing data to track and trend common claims issues: 2 years (Required)
• Direct Provider Engagement: 1 year (Required)

Willingness to travel:

• 25% (Required)

Work Location: Remote

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