[Remote] Encounter Data Management Professional at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Health InsuranceIndustries

Requirements

Candidates must have at least 2 years of experience in encounter submissions and claims processing, with a minimum of 1 year in the health insurance industry. A proven track record of root cause analysis and resolution, strong analytical and problem-solving skills, and proficiency in Microsoft Office Suite are required. Experience with Microsoft SQL or SAS is preferred, as is a Bachelor's degree in a related field. Home office requirements include high-speed DSL or cable internet with a minimum speed of 25mbps download and 10mbps upload, and a dedicated, interruption-free workspace.

Responsibilities

The Encounter Data Management Professional will ensure data integrity for claims errors and develop business processes for encounter submissions and reconciliation with Medicaid/Medicare. They will analyze data to ensure compliance with standards, develop tools to improve encounter acceptance rates, and identify long-term process improvements. This role involves interpreting data, making independent decisions, and managing multiple tasks and deadlines while maintaining attention to detail.

Skills

Encounter submissions

Claims processing

Analytical skills

Critical thinking

Problem-solving

Root cause analysis

Process documentation

Task management

Attention to detail

Communication

Microsoft Office Suite

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Microsoft Outlook

Microsoft SQL

SAS

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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