Role: Provider Network Operations Consultant Assignment: Location: Austin, TX
Healthcare isn’t just about health anymore. It’s about caring for family, friends, finances, and personal life goals. It’s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we’re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.
Assignment Capsule As a Provider Network Operations consultant you will: provide strategic leadership and consultation services for the PNO area. You will complete analyses and prepare disclosure materials while interacting and building partnerships with Humana's code editing, communications, and information technology teams and with external vendors.
Assist vendors, providers and Humana market offices with questions related to billing for hospital bill audits, specialty audits, Diagnosis-Related Group audits, and Skilled Nursing Facility audits
Develop audit tools and conduct reviews at providers’ offices
Act as a liaison between multiple business partners to identify and resolve problems and concerns
Verify the accuracy of diagnosis information submitted on claims/encounters for the purposes of risk adjustment
Use your claims knowledge to build a greater understanding of disclosure requirements for information about code editing logic
Triage assignments based on urgency, utilizing your knowledge to ensure escalation when necessary
Bachelor’s Degree in Business or a related field
Extensive knowledge of multiple types of Current Procedural Terminology and Healthcare Common Procedure coding systems
Comprehensive knowledge of Microsoft Word, Excel and Access
Reporting Relationships You will report to a Director. This area is under the direction of the SVP & Chief Operating Officer.
At Humana, we know your well-being is important to you, and it’s important to us too. That’s why we’re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.
After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on what’s happening around our organization in the changing world of healthcare.
Title: Provider Engagement Consultant - Austin, TX
Requisition ID: 178434