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Humana AI Business Partner Management Professional 2 (Remote US) in Overland Park, Kansas

Description

Humana's Provider Payment Integrity organization is looking for several AI Business Partner Management Professional 2's to join the Data Mining Vendor Management team, working on the Machinify project! As an AI Business Partner Management Professional 2 (internally known as a Vendor Management Professional 2) you will act as a liaison between AI business partners and the organization. You will make decisions on moderately complex issues regarding technical approach for project components.

Responsibilities

The AI Business Partner Management Professional 2 reviews and negotiates claims payment processes and builds and maintains positive relationships with business partners and monitors partner performance. Additionally, you will research invoice and contractual issues and resolve discrepancies.

Core Responsibilities

  • Perform quality audits on PPI business partner concepts/claim submissions to determine claims and overpayment accuracy, giving immediate feedback to peers, leaders, and assigned partner(s) as needed

  • Root cause analysis of process issues, providing solutions to project leaders

  • Act as a liaison between internal areas and project leaders as needed

  • Lead internal calls with peer teams as needed

  • Provide training when needed for our offshore audit team or other peer teams involved in the project

  • Help monitor partner quality and provide ad hoc reports as needed

  • Identify data trends, develop solutions to improve processes, and assist with presenting and implementing recommendations and solutions

Required Qualifications

  • Bachelor's degree or equivalent related work experience

  • 2+ years Provider Payment Integrity (formally known as Financial Recovery) experience

  • 3+ years CAS and MTV claims experience (determining if a claim paid correctly in the system)

  • Strong verbal and written communication skills

  • Strong facilitation skills

  • Proficient in Microsoft Office applications including Word, Excel and PowerPoint

Work at Home/Remote Requirements

  • Must ensure designated work area is free from distractions during work hours and virtual meetings

  • Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Preferred Qualifications

  • Prior Business Partner/Vendor Management experience

  • Knowledge of Medicare Advantage

  • Grievance and Appeals experience

  • AI Experience

Scheduled Weekly Hours

40

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