Billing Specialist
Within Health
Medical Director, Medicare Grievances and Appeals
Humana
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $246,100 - $344,200 per year
Job Level
Lead
About the role
- The Corporate Medical Director relies on medical background and reviews health claims.\n
- The Corporate Medical Director works on problems of diverse scope and complexity ranging from moderate to substantial.\n
- The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards.\n
- Represents Humana at Administrative Law Judge hearings.\n
- Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.\n
- Schedule is Monday-Friday with intermittent weekends.\n
- Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.\n
- Work from Home Guidance: internet speed requirements (min 25 Mbps download, 10 Mbps upload) and dedicated space to protect PHI / HIPAA data.\n
- For associates living in CA, IL, MT, or SD, bi-weekly internet expense provided.\n
- Humana provides telephone equipment to meet business requirements.\n
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Requirements
- MD or DO degree\n
- A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment\n
- Board Certified in an approved ABMS Medical Specialty\n
- Excellent communication skills\n
- 5 years of established clinical experience\n
- Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products\n
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences\n
- Preferred Qualifications: Medical utilization management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.\n
- Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, PM&R, Anesthesiology and General Surgery clinical specialists
