Role Description As the Manager, Payment Integrity, you will use technology and data mining, detecting anomalies in data to identify and collect overpayment of claims. You will contribute to the investigations of fraud waste and our financial recovery. You will work within specific guidelines and procedures; apply advanced technical knowledge to solve moderately complex problems; receiving assignments in the form of objectives and determines approach, resources, schedules and goals. Will lead a team of Professionals. - The Manager Payment Integrity Professional contributes to overall cost reduction by influencing department strategy. - Exceptional Certified Professional Coder with advanced knowledge in Medicare/Medicaid guidelines. - Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. - Exercises considerable latitude in determining objectives and approaches to assignments. - Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. - Fosters relationships between Code Edit Management, internal stakeholders such as Medicaid markets and multiple external code editing vendors. - Directly responsible for the code edit maintenance process, which ensures code editing denials remain accurate. - Will manage a team of professional level associates. Qualifications - Certified Professional Coder - 6 or more years of work experience related to claims (claims research and review) - 2 or more years of experience leading people or projects - Demonstrated experience with cross departmental collaboration - Experienced leading meetings and presenting material to broad audiences Requirements - Ability to determine the needed approach, resources, and goals to solve problems - Ability to handle multiple priorities - Capacity to maintain confidentiality - Excellent communication skills both written and verbal Preferred Qualifications - Experience with the following systems: CAS, MTV, CISpro and CIS - Knowledge of Microsoft Office Programs Access and Project - Experience in a fast paced, metric driven operational setting - Project Management Professional (PMP) Certification Benefits - 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 - Many other opportunities Additional Information - This role is "remote/work at home" and can be based anywhere in the United States. - To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service must meet the following criteria: - At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. - Satellite, cellular and microwave connection can be used only if approved by leadership. - Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. - Humana will provide Home or Hybrid Home/Office employees 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. - While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. - Scheduled Weekly Hours: 40 - Pay Range: $94,900 - $130,500 per year - This job is eligible for a bonus incentive plan based upon company and/or individual performance.