[Remote] Billing and Reconciliation Representative at Humana

Wisconsin, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

1+ years of experience in accounts receivable
Intermediate skills with Excel documents (sorting, filtering, copying and pasting)
Passionate about contributing to an organization focused on continuously improving consumer experiences
Ability to work during core business hours of 8:00am-4:30pm CST, Monday-Friday

Responsibilities

Reconciliation of revenue received from the Wisconsin Department of Health Services for members enrolled in iCare and Inclusa long term care Medicaid programs
Reconciliation of monthly capitation payments received for each member
Documenting any problems found during reconciliation and providing appropriate plans for resolution
Conducting follow up to resolve discrepancies
Providing exceptional customer service and updating all interested parties about the status of issues
Identifying enrollment and member billing discrepancies as they relate to capitation revenue received
Conducting follow up internally and with external organizations such as county Income Maintenance Consortiums and local Aging and Disability Resource Centers
Preparing and submitting contractually required discrepancy and overpayment reports to the Department of Health Services
Making decisions typically focused on methods, tactics, and processes for completing administrative tasks/projects
Exercising discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes, and techniques

Skills

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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