CenterWell Home Health
Claims Research & Resolution Professional
CenterWell Home Health, Indianapolis, Indiana, us, 46262
Become a part of our caring community and help us put health firstHumana Healthy Horizons in Indiana is seeking Claims Research & Resolution Professionals who are responsible for conducting root cause analyses of claims data to track and trend claims denials or rework, underpayments, and claims errors. The Claims Research & Resolution Professionals will engage with providers, one-on-one or in group settings, to educate them on appropriate claims submission processes and requirements, coding updates, and common billing errors to reduce claims denials and assists providers in getting reimbursed timely and accurately.
The Claims Research & Resolution Professionals work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Claims Research & Resolution Professional roles and responsibilities include:Routinely tracks and trends provider claims denials and rework to determine root cause.Conducts training with providers or groups of providers and their staff on claims denials, rework, and/or underpayments based on trended provider claims issues and common claims errors.Escalates any trended claims issues stemming from internal systems issues to the Senior Claims Research & Resolution Professional and assist in development of solutions to resolve those issues within our claims processing systems.Convenes billing forums with selected provider associations where providers can ask billing questions and/or receive guidance.Monitors providers post-training to ensure the issues causing the denials are resolved.Partners with Provider Education & Outreach Representatives to ensure prompt resolution of provider inquiries, concerns, or problems associated with claims payment.Assists with development of provider bulletins or training documents related to common claims issues and billing inaccuracies.Works with internal corporate partners to ensure cross-department communication and resolution of providers issues.Understands department, segment, and organizational strategy and operating objectives, including their applications to assignments.
Use your skills to make an impactRequired QualificationsMust reside in the state of Indiana.Must be able to travel in the state of Indiana to provider offices and Humana locations
with a potential in-office work requirement on occasion.2+ years of health insurance claims experience, such as claims education, claims processing.Experience working for or with key provider types (primary care, FQHCs, hospitals, nursing facilities, and/ Long Term Services and Supports (LTSS) and Home and Community Based Services (HCBS) providers).Experience analyzing data to track and trend common claims issues.Exceptional time management and ability to manage multiple priorities in a fast-paced environment.Intermediate to advanced knowledge of Microsoft Office applications.This role is a part of Humanas Driver Safety program and therefore requires an individual to have a valid state drivers license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.Preferred QualificationsBachelor's degree.Experience with Indiana Medicaid.Thorough understanding of managed care contracts, including contract language and reimbursement.Experience with claims systems, adjudication, submission processes, coding, and/or dispute resolution.Additional Information:Workstyle:
Remote but may vary due to travel and occasional onsite work at the Humana Healthy Horizons office in Indiana ( with a potential in-office work requirement on occasion).Travel:
Up to 25% travel in the state of Indiana to provider offices and Humana locations.Core Workdays & Hours:
Monday Friday; 8:00am 5:00pm Eastern Standard Time (EST).Benefits:
Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....Work at Home RequirementsAt minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.Satellite, cellular and microwave connection can be used only if approved by leadership.Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Interview FormatAs part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.Scheduled Weekly Hours40
Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $57,700 - $79,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, Humana) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About usHumana Inc. (NYSE: HUM) is committed to putting health first for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana?to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
The Claims Research & Resolution Professionals work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Claims Research & Resolution Professional roles and responsibilities include:Routinely tracks and trends provider claims denials and rework to determine root cause.Conducts training with providers or groups of providers and their staff on claims denials, rework, and/or underpayments based on trended provider claims issues and common claims errors.Escalates any trended claims issues stemming from internal systems issues to the Senior Claims Research & Resolution Professional and assist in development of solutions to resolve those issues within our claims processing systems.Convenes billing forums with selected provider associations where providers can ask billing questions and/or receive guidance.Monitors providers post-training to ensure the issues causing the denials are resolved.Partners with Provider Education & Outreach Representatives to ensure prompt resolution of provider inquiries, concerns, or problems associated with claims payment.Assists with development of provider bulletins or training documents related to common claims issues and billing inaccuracies.Works with internal corporate partners to ensure cross-department communication and resolution of providers issues.Understands department, segment, and organizational strategy and operating objectives, including their applications to assignments.
Use your skills to make an impactRequired QualificationsMust reside in the state of Indiana.Must be able to travel in the state of Indiana to provider offices and Humana locations
with a potential in-office work requirement on occasion.2+ years of health insurance claims experience, such as claims education, claims processing.Experience working for or with key provider types (primary care, FQHCs, hospitals, nursing facilities, and/ Long Term Services and Supports (LTSS) and Home and Community Based Services (HCBS) providers).Experience analyzing data to track and trend common claims issues.Exceptional time management and ability to manage multiple priorities in a fast-paced environment.Intermediate to advanced knowledge of Microsoft Office applications.This role is a part of Humanas Driver Safety program and therefore requires an individual to have a valid state drivers license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.Preferred QualificationsBachelor's degree.Experience with Indiana Medicaid.Thorough understanding of managed care contracts, including contract language and reimbursement.Experience with claims systems, adjudication, submission processes, coding, and/or dispute resolution.Additional Information:Workstyle:
Remote but may vary due to travel and occasional onsite work at the Humana Healthy Horizons office in Indiana ( with a potential in-office work requirement on occasion).Travel:
Up to 25% travel in the state of Indiana to provider offices and Humana locations.Core Workdays & Hours:
Monday Friday; 8:00am 5:00pm Eastern Standard Time (EST).Benefits:
Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....Work at Home RequirementsAt minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.Satellite, cellular and microwave connection can be used only if approved by leadership.Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Interview FormatAs part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.Scheduled Weekly Hours40
Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $57,700 - $79,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, Humana) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About usHumana Inc. (NYSE: HUM) is committed to putting health first for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana?to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.