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DescriptionHumana'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.ResponsibilitiesThe 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 ResponsibilitiesPerform 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 QualificationsBachelor'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 RequirementsMust 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 QualificationsPrior Business Partner/Vendor Management experience
Knowledge of Medicare Advantage
Grievance and Appeals experience
AI Experience
Scheduled Weekly Hours40
