Become a part of our caring community and help us put health first
 

The Provider Quality Audit Professional 2 operates within well-defined guidelines and procedures, applying independent judgment to analyze variable factors and resolve basic issues. This role involves collaboration with management and subject matter experts to determine appropriate methods, techniques, and analytical strategies.

The Provider Quality Audit Professional 2 plays a key role in supporting contract analysis, documentation management, and knowledge sharing within the organization. This position involves evaluating the financial impact of contract terms, maintaining accurate records in tracking systems, and assisting with the development of standardized templates, and policies to promote best practices.

• Researchs provider contract details
• Compares State Medicaid website payment terms
• Indicates specific defects noted within the auditing tool
• Collaborates with their teammates weekly
• Identifies self learning needs and collaborates with subject matter experts to inform of training content

In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:

• Medical Benefits
• Dental Benefits
• Vision Benefits
• Health Savings Accounts
• Flex Spending Accounts
• Life Insurance
• 401(k)
• PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
• And more

Use your skills to make an impact
 

Required Qualifications

• Analysis and researching proficiency
• 2+ years expertise in APEX, PIMS, PAAG, PAEG
• 2+ years of experience utilizing Mentor 
• 2+ years’ Fee Schedule Management interpretation experience in CAS
• 2+ years’ experience reviewing and interpreting provider contract language
• 2+ years’ Provider Screen interpretation experience in CAS
• Contract information systems (CIS) knowledge and CISPRO
• Working comprehensive knowledge of Microsoft Office applications, including Word and Excel
• Excellent Verbal and written communication skills
• Strong attention to detail

Preferred Qualifications

• Basic understanding of the provider credentialing process and credentialing systems
• Working knowledge of contract load area/s
• 1+ year of benefit interpretation experience
• Ability to interact with all levels of leadership
• Regulatory compliance knowledge
• Clinical experience
• Microsoft Access proficiency (queries, joined tables, etc.)
• Experience working with governmental agencies

Additional Information

WORK STYLE: Remote/Work at home. Minimal need to travel (less than 1%) for training, meeting, and/or conferences.

WORK HOURS:  Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Some flexibility may be possible, depending on business needs. Flex hours are available once training is completed. Less than 1% opportunity for overtime hours.

Work at Home/Remote Requirements

Work-At-Home Requirements

• To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
  • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.
  • Wireless, Wired Cable or DSL connection is suggested.
  • Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership.  (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
  • Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota.  Associates 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 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

Our Hiring Process

As part of our hiring process, we will be using an ex