Job Details


Company name
Humana Inc.

Louisville, KY

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Role: Inpatient Clinical Audit Manager

Assignment: Provider Payment Integrity

Location: Louisville, KY office or Work from home driving distance to the office

Healthcare isn\u2019t just about health anymore. It\u2019s about caring for family, friends, finances, and personal life goals. It\u2019s about living life fully. At Humana, we want to help people everywhere, including our associates, lead their best lives. We support our associates to be happier, healthier, and more productive in their professional and personal lives. We encourage our people to build relationships that inspire, support, and challenge them. We promote lifelong well-being by giving our associates fresh perspective, new insights, and exciting opportunities to grow their careers. At Humana, we\u2019re seeking innovative people who want to make positive changes in their lives, the lives of our members, and the healthcare industry as a whole.

Assignment Capsule
Be a part of the Provider Network world-- Evaluate the business and system processes through the eyes of customers, members and provider partners leads to measurable improvements in cost, quality and speed to market.
As an Inpatient Clinical Audit Manager in the Provider Payment Integrity department, you will provide guidance based on quality and education of Nurses and Coders. You will also manage dispute inventory; age, excellence, responsiveness. You will work with multiple business areas to achieve the highest results and gain for the company.

Work with teams and leadership to implement improvement initiatives.
This role will focus on clinical audits trends of inpatient claims.
Consult with all PPI Clinical Audit teams to have a cohesive relationship, communicate and convey results/developments.
Manage all quality reviews and trending of the onshore, offshore & vendors.
Ensure and plan for education sessions/CEU\u2019s for Coders/RN\u2019s.
Review all Level 1 Disputes from Internal Clinical teams.
Actively participate in process improvement and projects while collaborating with other teams.
Please note: this role requires the ideal candidate to work out of the Louisville office until the leader feels the Associate is acclimated to the role.

Role Essentials

Bachelor's degree or equivalent combination of education and experience.
Ability to work independently and apply critical thinking, self-driven, flexible with change
Demonstrated competency in both oral and written communication skills.
Minimum of 3 years leadership experience
Strong research and collaboration skills
Solid understanding of process / work flow concepts
Strong research, problem-solving, analytical and negotiation skills
Strong computer skills including MS Office applications (Word, Excel, PowerPoint)
Strong written and verbal communication skills

Roles Desirables

Claims processing knowledge (3 years)
Coding knowledge (CPC preferred, but not required)
Registered Nurse (RN)
Master\u2019s Degree in Business, Finance or related

Reporting Relationships
You will report to a Program Manager. This area is under the direction of the SVP & Chief Operating Officer.

Additional Information
At Humana, we know your well-being is important to you, and it\u2019s important to us too. That\u2019s why we\u2019re committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. If you share our passion for helping people, we likely have the right place for you at Humana.

After applying, we encourage you to join our Talent Network as well, so you can stay informed and up to date on what\u2019s happening around our organization in the changing world of healthcare.
Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Company info

Humana Inc.
Website :

Company Profile
Humana's diverse lines of business work to serve all types of consumers. From families to seniors to military members to self-employed individuals, there is a plan to meet many unique needs. Find out how Humana's associates and corporate leaders are committed to customer service. Our team uses innovation to deliver results to our consumers.

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