Humana Inpatient Clinical Audit Manager in Louisville, Kentucky

Role: Inpatient Clinical Audit Manager Assignment: Provider Payment Integrity Location: Louisville, KY office or Work from home driving distance to the office

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 Be a part of the Provider Network world-- Evaluate the business and system processes through the eyes of customers, members and provider partners leads to measurable improvements in cost, quality and speed to market.

As an Inpatient Clinical Audit Manager in the Provider Payment Integrity department, you will provide guidance based on quality and education of Nurses and Coders. You will also manage dispute inventory; age, excellence, responsiveness. You will work with multiple business areas to achieve the highest results and gain for the company. * Work with teams and leadership to implement improvement initiatives.

  • This role will focus on clinical audits trends of inpatient claims.

  • Consult with all PPI Clinical Audit teams to have a cohesive relationship, communicate and convey results/developments.

  • Manage all quality reviews and trending of the onshore, offshore & vendors.

  • Ensure and plan for education sessions/CEU’s for Coders/RN’s.

  • Review all Level 1 Disputes from Internal Clinical teams.

  • Actively participate in process improvement and projects while collaborating with other teams.

  • Please note: this role requires the ideal candidate to work out of the Louisville office until the leader feels the Associate is acclimated to the role.

    Role Essentials

  • Bachelor's degree or equivalent combination of education and experience.

  • Ability to work independently and apply critical thinking, self-driven, flexible with change

  • Demonstrated competency in both oral and written communication skills.

  • Minimum of 3 years leadership experience

  • Strong research and collaboration skills

  • Solid understanding of process / work flow concepts

  • Strong research, problem-solving, analytical and negotiation skills

  • Strong computer skills including MS Office applications (Word, Excel, PowerPoint)

  • Strong written and verbal communication skills Roles Desirables

  • Claims processing knowledge (3 years)

  • Coding knowledge (CPC preferred, but not required)

  • Registered Nurse (RN)

  • Master’s Degree in Business, Finance or related Reporting Relationships You will report to a Program Manager. This area is under the direction of the SVP & Chief Operating Officer.

    Additional Information 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: Inpatient Clinical Audit Manager

Location: KY-Louisville

Other Locations: US-IN-Indianapolis

Requisition ID: 181437

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.