Encounter Data Management Professional 1

Employment Type: Full time Location Type: Remote (anywhere in the US) Salary: Not specified

Position Overview

Humana’s Encounter Data Management (EDM) team is seeking an Encounter Data Management Professional 1 with experience in business processing and data entry to join our remote team. In this role, you will identify complex errors and problems within the encounter process between Humana and CMS. You will utilize data analysis, claims research, and other resources to provide insights and ensure data integrity for Medicare/Medicaid claims errors.

Key Role Functions

• Develop business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare.
• Ensure encounter submissions meet or exceed all compliance standards via analysis of data.
• Develop tools to enhance the encounter acceptance rate by Medicaid/Medicare.
• Identify and implement long-term improvements for encounter submission processes.
• Maintain partnerships with relevant departments and communicate with their leadership to highlight impacts that will result in change, ultimately decreasing the amount of errors.
• May attend Medicaid/Medicare state partner meetings.
• May be assigned additional projects, stretch assignments, and/or additional duties.

Required Qualifications

• Business processing experience.
• Prior financial reporting and/or related finance experience.
• Experience using DOS type systems.
• Strong analysis, critical thinking, and analytical problem-solving skills.
• Ability to manage multiple tasks and deadlines with attention to detail.
• Excellent communication skills.
• Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Preferred Qualifications

• Prior health insurance industry experience.
• Working knowledge of Microsoft SQL or SAS.
• Medicare and/or Medicaid experience.

Additional Information

Internet Service Requirements for Remote Employees:

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps recommended.
• Wireless, wired cable, or DSL connection is suggested.
• Satellite, cellular, and microwave connections may be used only if approved by leadership.
• Employees in California, Illinois, Montana, or South Dakota will receive a bi-weekly internet expense payment.

Technology and Work Environment:

• Humana will provide appropriate telephone equipment.
• Work from a dedicated, interruption-free space to protect member PHI / HIPAA information.

Humana Benefits

Humana offers a variety of benefits to promote employee health and well-being, including:

• Health benefits effective day 1.
• Paid time off, holidays, volunteer time, and jury duty pay.
• Recognition pay.
• 401(k) retirement savings plan with employer match.
• Tuition assistance.
• Scholarships for eligible dependents.
• Parental and caregiver leave.
• Employee charity matching program.
• Network Resource Groups (NRGs).
• Career development opportunities.

Hiring Process

As part of our hiring process, we may contact you via text message and email to gather more information using the HireVue platform. HireVue technologies allow you to interact with us at your convenience. If selected to move forward, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging, and/or Video interview.