Dental Fraud and Waste Investigator

Profile

Description

The Dental Fraud and Waste Investigator conducts investigations of allegations of fraudulent and abusive practices. The Dental Fraud and Waste Investigator work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Dental Fraud and Waste Investigator coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports.

Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

WORK STYLE: This is a fully remote/work at home role and can be performed from anywhere in the US (employees might have the opportunity to work from a local Humana office, if they'd like to do so).

WORK HOURS: Work will be performed Monday-Friday, 8 hours per day/5 days per week. Core business hours are 6AM-6PM EST, depending on business needs.

Required Qualifications

Dental clinical experience (eg dental hygienist, dental billing/coding, dental assistant, office manager in a dental office)

Healthcare investigations and/or auditing experience

Knowledge of dental payment methodologies (eg coding, billing)

Strong organizational, interpersonal, and communication skills

Inquisitive nature with ability to analyze data to metrics

Computer literate (MS, Word, Excel, Access)

Strong personal and professional ethics

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Minimal travel (for trainings, meetings, and conferences) is possible

Preferred Qualifications

Bachelor's degree and/or certifications (CDC, RDA, RDH, AHFI, CFE)

Understanding of healthcare industry, claims processing and investigative process development.

Experience in a corporate environment and understanding of business operations

Additional Information

Work at Home Requirements

WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

Satellite and Wireless Internet service is NOT allowed for this role.

A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Additional Information - How We Value You

Benefits starting day 1 of employment

Competitive 401k match

Generous Paid Time Off accrual

Tuition Reimbursement

Parental Leave

Go365 perks for well-being

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

#ThriveTogether #WorkAtHome

Scheduled Weekly Hours

40

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Company info

Humana Inc.
Website : http://www.humana.com