Representative Jobs

Description The Senior Value-Based Programs Analyst supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Senior Value-Based Programs Analyst works on problems ..

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 ..

Description The Medical Coding Auditor reviews medical records to verify coding (ICD-10 CM/PCS). The Medical Coding Auditor work assignments are varied and frequently require interpretation and independent determination of the appropriate ..

Job ID 21000LQSAvailable Openings 1PURPOSE AND SCOPE: Provides psychosocial services to patients treated by the facility including in-center and home dialysis patients (if applicable) utilizing Social Work Theory of Human Behavior ..

Description The Healthcare Financial Analyst collects, analyzes, and reports on various market data, connecting operational effectiveness and member experience to financial outcomes. Responsibilities The East Central Region is seeking a Healthcare ..

Job ID 21000LWUAvailable Openings 1PURPOSE AND SCOPE: Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. ..

Job Information Humana Care Guide - Physical Health in Lima Ohio Description The Care Guide (Care Coach 1) assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness ..

Description Humana Healthy Horizons in Ohio is seeking a Care Guide/Care Guide Plus (Care Coach 1) who will assess and evaluate member's needs and requirements to achieve and/or maintain optimal wellness ..

Job ID 21000LQSAvailable Openings 1Position Specific Information This role is full-time with beneifits, 30 hours per week during normal business hours. PURPOSE AND SCOPE: Provides psychosocial services to patients treated by ..

Job Information Humana Senior Provider Contracting Professional - Remote (EST Hours) in Lima Ohio Description The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and ..

Description The Physician Performance Insights team's mission is to empower Humana members to make informed healthcare decisions. Our key goal is to ensure transparency and help our members obtain high quality ..

Description The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Executive works on problems ..

Job Information Humana Outpatient Medical Coding Auditor-Remote/Virtual in US in Lima Ohio Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology ..

Job Information Humana Inpatient Medical Coding Auditor-Remote/Virtual in US in Lima Ohio Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology ..

Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM and PCS) to patient records. The Medical ..

Description The Manager, Risk Adjustment oversees coding educators and quality assurance audits of medical records and ICD-9/10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS). ..

Description This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will oversee the monitoring and enforcement of the fraud, waste, and abuse (FWA) compliance program to ..

Description The Senior Value-Based Programs Analyst supports successful value-based provider relationships in the Service Fund Department with a focus on improving the provider experience and achieving path-to-value goals through analysis and ..

Job Information Humana Manager, Fraud and Waste-Remote US in Lima Ohio Description The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste ..

Job Information Humana Inpatient Medical Coding Auditor (MSDRG/ APDRG)-Remote/Virtual in US in Lima Ohio Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate ..

Job Information Humana Contract Tools, Education, Processes Professional - Louisville, KY or Remote (EST hours) in Lima Ohio Description The Contract Tools, Education, Processes Professional builds templates, standard documentation, policy and ..