Associate Director Medical/Financial Risk Evaluation Remote US

Profile

Description

Responsibilities

The Associate Director Medical/Financial Risk Evaluation leads a few powerful teams dedicated to reducing waste and abuse in the health care industry and its impacts on Humana. These teams help to understand gaps where we need new policies, claims are not paying correctly or there is a gap causing claims payment to not be 100% accurate. The teams that report to this Associate director will assist in identifying 'NEW' opportunities where payment is not aligned with policies of both Humana, CMS and the industry. You will partner with Clinical, SIU, Claims Process Organization, Markets and Provider Contracting to validate the risks and recover dollars owed to Humana as well as develop and lead presentations to senior leaders in those areas. As the Associate Director, you will lead a team of 6 direct reports with approx. 64 total associates.

This is a remote role working anywhere in the US. If you are located in Louisville, KY (preferred) this role will be a hybrid of remote and in-office once CDC restrictions have lifted.

Required Qualifications


Bachelor's Degree or equivalent related work experience
6 years of Healthcare industry experience
2 years of people management experience
Ability to identify and quantify financial impacts
Strong written and verbal communication skills with the ability to collaborate with cross-functional teams and present to senior leaders


Work at Home Requirements


Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required
A dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information


Preferred Qualifications


Located in Louisville, KY (Strongly preferred)
Experience in Fraud, Waste and Abuse
Fraud certification(s)


Additional Information

Based on current guidance from the CDC, local and state governments, and Humana leadership related to the coronavirus (COVID-19) outbreak have extended travel restrictions until further notice. The policy will be reassessed as the situation warrants. Once these restrictions are lifted this role may require up to 20% travel depending on business needs for anyone not located in Louisville, KY .

Scheduled Weekly Hours

40

Company info

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