HIM Clinical Data Quality Auditor and Educator
Virta HealthSalary not specified
- Full Time
- Junior (1 to 2 years)
Not SpecifiedCompensation
Junior (1 to 2 years)Experience Level
Full TimeJob Type
UnknownVisa
HealthcareIndustries
Requirements
Candidates must possess a Bachelor's degree, a minimum of two years of experience conducting comprehensive healthcare fraud investigations, and strong analytical skills with the ability to make deductions and logical conclusions. They should also demonstrate strong personal and professional ethics, and the ability to work independently with minimal supervision.
Responsibilities
The Fraud and Waste Professional 2 will conduct investigations of reported or suspected fraud involving Florida's Medicaid Program, coordinate investigations with law enforcement authorities, assemble evidence and documentation, conduct on-site audits of provider records, prepare investigative and audit reports, and understand department strategy and operating objectives. The role also involves making decisions regarding work methods and adhering to established guidelines and procedures.
Skills
Healthcare Fraud Investigation
Medical Coding
Medical Chart Review
Insurance Billing
Auditing
Regulatory Compliance
Claims Investigation
Criminal Investigation
Law Enforcement Interaction
Report Writing
Analytical Skills
Independent Work
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.
Key Metrics
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees