Clinical Documentation Reviewer
Interwell HealthSalary not specified
- Full Time
- Junior (1 to 2 years)
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Managed Care, Health ServicesIndustries
Requirements
Candidates should possess a Bachelor’s degree and a minimum of 3 years of healthcare experience in revenue cycle management, specifically related to billing, coding, and collections for Medicare and Medicaid claims. They must have experience with auditing and monitoring of healthcare records, the ability to work core business hours on EST time between 9am-5pm, and a willingness to travel up to 10% to conduct audits at site locations. Strong attention to detail, effective verbal and written communication skills, and the ability to manage multiple priorities are also required.
Responsibilities
As the Senior Clinical Compliance Professional, the individual will assess compliance risks to PCO, design auditing and monitoring activities, execute assigned portions of the compliance workplan, conduct compliance audits, influence department strategy by identifying continuous monitoring activities, provide reporting on metrics and M&A activity related to revenue cycle management, and serve as a regulatory compliance subject matter expert communicating requirements to business leaders. They will also coordinate site visits for regulators, coordinate implementation and compliance with corrective action plans, and research compliance issues and recommend changes to ensure compliance with federal and state requirements related to Provider Clinic operations, billing, investigations, and processes.
Skills
Healthcare Compliance
Regulatory Auditing
Policy Development
Investigation & Research
Corrective Action Plans
Federal & State Healthcare Regulations
Healthcare Operations
Internal Controls
Regulatory Coordination
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