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Senior Vendor Management Professional - Machinify (Remote)

at Humana in Rogers, Arkansas, United States

Job Description

Description

Humana’s Provider Payment Integrity organization is looking for a Senior Vendor Management Professional to join the Data Mining Vendor Management team! As the Senior Vendor Management Professional you will act as a liaison between business partners and the organization. You will make decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.

Responsibilities

As the Senior Vendor Management Professional you will review and negotiate terms of business partner contracts and communicate with business partners regarding day-to-day matters. You will build and maintain positive relationships with vendors and monitor vendor performance as well as research invoice and contractual issues and resolve discrepancies.

Core Responsibilities

+ Perform routine quality audits on PPI data mining partner concepts to determine payment accuracy, giving immediate feedback to assigned partner(s) as needed

+ Act as a liaison between internal areas and our PPI business partners

+ Lead business partner conference calls and meetings

+ Provide training when needed for PPI data mining business partners and other internal teams (i.e. audit team) involved with the AI program

+ Report/resolve security and system issues for external partners

+ Monitor partner quality and provide ad hoc reports as needed

+ Identify data trends, develop solutions to improve processes, and assist with presenting and implementing recommendations and solutions

+ Lead and provide solutions on any escalated disputes and subsequent clean-up efforts

Required Qualifications

+ Bachelor’s degree or equivalent related work experience

+ 3+ years of medical claims auditing experience (interpreting if claims initially paid correctly in the system)

+ 2+ years Provider Payment Integrity (formally known as Financial Recovery) experience

+ CAS and MTV claims knowledge/experience

+ Intermediate knowledge/experience with Microsoft Excel

+ Ability to confidently communicate verbally and via email with external vendor partners

+ Demonstrated strong emotional intelligence

+ Strong relationship building skills

Work at Home/Remote Requirements

+ Must ensure designated work area is free from distractions during work hours and virtual meetings

+ Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10×1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

+ Prior experience in a healthcare or medical insurance setting

+ Prior vendor relationship experience/knowledge

+ Prior AI experience/knowledge

+ Knowledge of Medicare Advantage

+ Certified Professional Coding

Scheduled Weekly Hours

40

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Job Posting: JC193156023

Posted On: Sep 24, 2021

Updated On: Sep 30, 2021