Encounter Data Management Professional

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health InsuranceIndustries

Requirements

Candidates must possess 1-5 years of claims processing experience, with at least 1 year dedicated to root cause analysis and resolution. A strong understanding of Microsoft Office Suite, including Word, PowerPoint, Outlook, and Excel, is essential, along with proven analytical reasoning, decision-making, and problem-solving skills. The ability to manage multiple tasks and deadlines with attention to detail is also required. A Bachelor's degree in business, finance, accounting, operations, or a related field is preferred, as is prior health insurance industry experience and working knowledge of Microsoft SQL or SAS.

Responsibilities

The Encounter Data Management Professional is responsible for ensuring data integrity by addressing claims errors and developing business processes for successful submission and reconciliation of encounter data to Medicaid/Medicare. This role involves analyzing data to ensure compliance standards are met or exceeded, creating tools to improve encounter acceptance rates, and identifying long-term process improvements. The professional will interpret and determine appropriate courses of action for varied work assignments, maintain clear documentation of project processes, and understand departmental and organizational strategies.

Skills

claims processing

root cause analysis

documentation

analytical reasoning

decision-making

problem-solving

Microsoft Office Suite

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Microsoft Outlook

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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