Humana is seeking a Genetic Counselor to assist in the detecting and investigation of potential fraud and provide clinical guidance to the Special Investigators handling the cases. This is an inward facing role, with no direct member interaction. The daily assignment capsule includes reviewing of medical records for fraud, waste or abuse as well as review of Humana Medical Coverage Policies, CMS regulations, peer reviewed literature, and professional society’s publications for applicable regulations.
Master’s Degree of Science in Genetic Counseling
Active license in the state requiring licensure
Board Certified Genetic Counselor
3+ years of experience in genetic counseling or related role
Proven successful experience in completing efficient health-related research, with associated analysis and conclusions
Excellent organizational skills desired with ability to handle multiple tasks and deadlines with attention to detail
Self-starter with the ability to work independently
Excellent written and oral communication skills required
3 or more years’ experience in the health industry, to include knowledge of CPT code billing.
Experience with research, analysis and root cause identification
Development of clinical and /or coding concepts and processes
Proficiency with Excel
Telecommuting is allowed.
Internal Number: R-238425
About Humana, Inc.
Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
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