Encounter Data Management Professional

San Antonio, Texas, United States

Apply with AI Apply

Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must have business processing experience, prior financial reporting or related finance experience, and experience using DOS type systems. Strong analytical skills, critical thinking, and problem-solving abilities are essential, along with the capacity to manage multiple tasks and deadlines with attention to detail. Excellent communication skills and comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel, are required. Prior health insurance industry experience, working knowledge of Microsoft SQL or SAS, and Medicare/Medicaid experience are preferred qualifications.

Responsibilities

The Encounter Data Management Professional will develop business processes to ensure the successful submission and reconciliation of encounter submissions to Medicaid/Medicare, ensuring compliance with all standards through data analysis. They will create tools to improve the encounter acceptance rate, identify complex errors in the encounter process using data analysis and claims research, and look for long-term improvements in submission processes. This role involves maintaining partnerships with departments, communicating impacts to leadership, and potentially attending Medicaid/Medicare state partner meetings or undertaking additional projects.

Skills

Encounter Data Management

Business Process Development

Data Analysis

Claims Research

Data Integrity

Compliance Standards

Process Improvement

Data Entry

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.

Land your dream remote job 3x faster with AI

Try Jobo Free