At Humana, we believe that every person deserves access to quality healthcare. As a Healthcare Claims Denials Specialist, you will play a vital role in ensuring that our members receive the coverage they need and deserve. We are looking for a dedicated and detail-oriented individual who is passionate about making a positive impact in the healthcare industry. If you have excellent problem-solving skills, strong communication abilities, and a thorough understanding of claims processing and reimbursement, we want you on our team. Join us at Humana and help us continue to provide exceptional care to our members.
- Review and analyze healthcare claims to identify potential denials and discrepancies.
- Work closely with insurance providers, healthcare providers, and members to resolve claim denials and ensure proper reimbursement.
- Conduct thorough research and investigations to determine the root cause of denials and develop strategies to prevent future denials.
- Communicate with healthcare providers and insurance companies to gather necessary information and documentation for claims appeals.
- Utilize knowledge of medical coding and billing procedures to accurately process claims and ensure compliance with industry regulations.
- Collaborate with cross-functional teams, including customer service, billing, and finance, to resolve complex claims issues.
- Maintain accurate and up-to-date records of claim denials, appeals, and resolutions.
- Identify opportunities for process improvement and work with management to implement effective solutions.
- Stay current on industry changes and updates related to claims processing and reimbursement.
- Uphold Humana's mission of providing quality healthcare to all members and promote a positive company image.
Knowledge Of Healthcare Billing And Coding: A Healthcare Claims Denials Specialist At Humana Should Have A Strong Understanding Of Medical Billing And Coding Procedures, Including Icd-10, Cpt, And Hcpcs Codes. This Knowledge Is Essential In Identifying And Resolving Claim Denials.
Experience With Claims Processing Software: Humana Uses Various Claims Processing Software Systems, And A Qualified Candidate Should Be Familiar With These Systems And Have Experience Navigating And Troubleshooting Them.
Understanding Of Insurance Policies And Regulations: A Healthcare Claims Denials Specialist Should Have A Thorough Understanding Of Insurance Policies And Regulations, Including Medicare, Medicaid, And Commercial Insurance Guidelines. This Knowledge Is Crucial For Determining The Validity Of Claim Denials And Appealing Them.
Strong Analytical And Problem-Solving Skills: This Role Requires The Ability To Analyze Complex Claim Denials And Identify The Root Cause Of The Issue. A Qualified Candidate Should Have Strong Critical Thinking And Problem-Solving Skills To Effectively Resolve Denials.
Attention To Detail: The Healthcare Claims Denials Specialist Role Requires A High Level Of Attention To Detail To Ensure Accurate And Timely Resolution Of Claims. This Includes Reviewing Medical Records, Claim Forms, And Other Documentation To Identify Errors And Discrepancies.
Data Analysis
Claims Processing
Compliance regulations
Medical Terminology
Electronic Health Records
Insurance Coding
Appeals Management
Medicare Guidelines
Claims Reimbursement
Denials Resolution
Provider Communication
Communication
Conflict Resolution
Emotional Intelligence
Leadership
Time management
creativity
Critical thinking
Teamwork
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Healthcare Claims Denials Specialist is between $44,000 to $69,000 per year. However, this can vary depending on factors such as location, experience, and the specific employer. Some specialists may make less than this range, while others may make more.
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Humana Inc. is a for-profit American health insurance company based in Louisville, Kentucky. Its strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people they serve across the country. The company operates its business through the following segments: Retail, Group, and Healthcare Services.
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