Humana Inc. Miami , FL 33196
The Director, Payment Integrity uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our financial recovery. The Director, Payment Integrity requires an in-depth understanding of how organization capabilities interrelate across the function or segment.
The Director, Payment Integrity contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance.
The Director of Payment Integrity will:
Drive strategic initiatives within the area and ensure that the alignment of departmental objectives are congruent with the overall business strategy
Provide innovative, creative, and strategic thinking in claims cost management, as it relates to the provider.
Lead and manager call center operations, quality oversight, department compliance, regulatory reporting, and analytics, as it relates to the provider.
Initiate and maintain productive long-term provider-client relationships with compliance department, legal department, call center, and audit area.
Apply economic and strategic planning models to all endeavors in your region in order to align business, process and operational principles with area-specific goals.
Build and sustain team synergy while maintaining accountability for results.
Bachelor's Degree in Business, Finance or a related field
Strong collaboration skills
Proven leadership skills managing a large team of indirect and direct reports
In depth knowledge of various reimbursement methodologies
Proficiency in analyzing and interpreting financial trends
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and Access
Master's Degree in Business Administration or a related field
Progressive experience in the contracting area for a health solutions industry
Experience working and communicating with providers
The location preference for this position is Louisville, KY or Green Bay, WI. However other locations will be considered for the right candidate.
Scheduled Weekly Hours