Vacancy caducado!
DescriptionDo you enjoy helping those in need? Do you love researching, analyzing medical documents to determine if something was missed? Have you ever considered yourself a detective for medical claims / member benefits? Well if you answered yes to any of the above you may be a great fit for Humana's Grievance & Appeals Representative 3 role.ResponsibilitiesWhat we need your help with:You will manage client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.
Perform advanced administrative and/or customer support duties that require independent initiative and judgment.
From time to time apply intermediate mathematical skills and regularly exercise discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques.
Work under limited guidance at the comfort of your home due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.
COME GROW WITH HUMANA! BENEFITS DAY ONE - STELLAR 401K MATCH - PAID TIME OFFWhat you need for success! - Required Qualifications2+ years working with customers in a fast-paced, deadline-oriented environment
High School Diploma or GED
Prior experience interpreting Member Benefits and Medical Claims
Experience with case management or the ability to prioritize and manage inventory and work flow
Strong attention to detail, organizational and time management skills with the ability to interpret, research and identify core issues
Strong customer focus, analytical and decision making skills
Strong technical skills with the ability to work across multiple software systems and comfortable work remote out of your home
Work at Home RequirementsMust 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.
What you need to be considered a Superstar! : Preferred QualificationsAssociate's or Bachelor's Degree
Prior experience with Humana's operating systems: MHK (MedHok), SRO / CAS / ARGUS, CI, CGX
Prior Medicare experience
Prior experience with CMS Guidelines and remaining compliant
High level of emotional intelligence with a proven ability to influence office culture and engagement in a positive manner
Additional InformationFlexibility - ability to work overtime including weekends, based on business needs
Department Hours- Shift could fall between business hours of 6:00am to 6:00 pm EST . Hours subject to change based on business needs
Training Hours - Training will start day one of employment and run the first 8 weeks with a schedule of 8am - 4:30 pm EST. Attendance is vital for success so little to no time off is allowed during training.
Scheduled Weekly Hours40
Vacancy caducado!