Provider Quality Audit Professional

Become a part of our caring community and help us put health firstThe Provider Quality Audit Professional 2 operates within well-defined guidelines and procedures, applying independent judgment to analyze variable factors and resolve basic issues. This role involves collaboration with management and subject matter experts to determine appropriate methods, techniques, and analytical strategies. The Provider Quality Audit Professional 2 plays a key role in supporting contract analysis, documentation management, and knowledge sharing within the organization. This position involves evaluating the financial impact of contract terms, maintaining accurate records in tracking systems, and assisting with the development of standardized templates, and policies to promote best practices. Researchs provider contract detailsCompares State Medicaid website payment termsIndicates specific defects noted within the auditing toolCollaborates with their teammates weeklyIdentifies self learning needs and collaborates with subject matter experts to inform of training contentIn addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:Medical BenefitsDental BenefitsVision BenefitsHealth Savings AccountsFlex Spending AccountsLife Insurance401(k)PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being timeAnd moreUse your skills to make an impact Required Qualifications Analysis and researching proficiency2+ years expertise in APEX, PIMS, PAAG, PAEG2+ years of experience utilizing Mentor 2+ years’ Fee Schedule Management interpretation experience in CAS2+ years’ experience reviewing and interpreting provider contract language2+ years’ Provider Screen interpretation experience in CASContract information systems (CIS) knowledge and CISPROWorking comprehensive knowledge of Microsoft Office applications, including Word and ExcelExcellent Verbal and written communication skillsStrong attention to detailPreferred QualificationsBasic understanding of the provider credentialing process and credentialing systemsWorking knowledge of contract load area/s1+ year of benefit interpretation experienceAbility to interact with all levels of leadershipRegulatory compliance knowledgeClinical experienceMicrosoft Access proficiency (queries, joined tables, etc.)Experience working with governmental agenciesAdditional InformationWORK STYLE: Remote/Work at home. Minimal need to travel (less than 1%) for training, meeting, and/or conferences. WORK HOURS: Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Some flexibility may be possible, depending on business needs. Flex hours are available once training is completed. Less than 1% opportunity for overtime hours. Work at Home/Remote RequirementsWork-At-Home RequirementsTo ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate. Wireless, Wired Cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA informationOur Hiring ProcessAs part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, 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, Text Messaging, and/or Video Interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone or computer. You should anticipate this interview to take approximately 10-15 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. If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours40Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$59,300 - $80,900 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 07-17-2025About usHumana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.​Equal Opportunity EmployerIt is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Originally posted on Himalayas Apply To this Job