Humana
Lincoln, NE, USA
Become a part of our caring community and help us put health first The Director, Payment Integrity uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. The Director leverages technology and the clinical and coding expertise of their associates to identify potential overpayments to be substantiated via review of medical records. The Director contributes to the investigations of fraud, waste and abuse. The Director requires an in-depth understanding of how organizational capabilities interrelate across the function or segment. The Clinical and Coding Medical Record Review Director of Payment Integrity contributes to overall cost reduction, by increasing the accuracy of provider payments in our payer systems, and by ensuring correct claims payment. The Director contributes to overall cost reduction, by increasing the accuracy of provider payments via a complex array of medical record audit programs performed by coders and...
