Become a part of our caring community and help us put health first
Healthcare Quality Reporting & Improvement (HQRI) is an organization responsible for improving health outcomes and advancing the care experience of our members and provider partners through integrated risk adjustment (RA) and quality (Stars) solutions that leverage data and technology to empower members, providers, and Humana.
The Risk Adjustment Prospective Provider Programs organization within HQRI delivers a portfolio of products to support physicians in providing optimal patient care and improving the accuracy of their clinical documentation. The products are a mix of in-house and vended solutions, with an eye toward growth of analytics-driven and interoperable solutions.
The Program Delivery Professional 2 supports the execution and operational performance outcomes for the provider programs. The Program Delivery Professional 2 work assignments are varied and may frequently require interpretation and independent determination of the appropriate courses of action.
The Program Delivery Professional 2 intakes vendor payment invoices and reconciles invoice amounts to budget. Collaborates with Risk Adjustment market staff to obtain provider invoices for payment. Generates incentive payments to providers for program participation. Monitors vendor outbound and inbound data files. Supports monitoring program operational SLA's and performance metrics. Tracks and works to resolve issues with vendor programs. Collaborates with internal and external business partners to inform and resolve program issues.
Use your skills to make an impact
Required Qualifications
Bachelors Degree
3+ years' experience with payment processing and budget management.
2+ years' experience with data file monitoring and error resolution.
Strong analytic skills and ability to use data to drive improvement activities.
Strong knowledge of Microsoft 365 products (Word, Excel).
Strong organizational and prioritization skills with the ability to collaborate with multiple departments.
Excellent communication skills, written and verbal.
Can work with limited supervision and determine appropriate courses of action.
Ability to handle multiple priorities.
Preferred Qualifications
Medicare Risk Adjustment experience.
Experience using Microsoft SQL.
Experience using Power BI reporting tools.
Additional Information
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At 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
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
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from *** with instructions on how to add the information into your official application on Humana's secure website.
Scheduled Weekly Hours
40
Pay Range
The 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.$69,800 - $96,200 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, 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 us
Humana 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 Employer
It 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 because he or she is a protected veteran. 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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***/legal/accessibility-resources?source=Humana_Website.