Encounter Data Management Professional

About the Role

Become a part of our caring community and help us put health first. The Encounter Data Management Professional will conduct research and analysis to execute accurate, timely, and completeness of DSNP encounter submissions.

Responsibilities

The Encounter Data Management Professional will have comprehensive knowledge of processes, policies and procedures as well as compliance guidelines. Will support achieving operational and compliance key performance indicators. In addition, the associate will participate in cross functional teams and support analyzing business processes, error processing, issues and ticket creations with the product management team. The Encounter Data Management Professional will support encounter processing, analytics and research of encounter submission inventory. The Encounter Data Management Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Use your skills to make an impact.

Required Qualifications

• Minimum 1 year of experience in medical claims payment and processing
• Minimum 1 year of experience analyzing and researching medical claims
• Proficient in Microsoft Office (Word, Excel, Access, PowerPoint)
• Working knowledge of SQL
• Familiarity with EDI X12 formats (837P/I/D, 999, 277, 835, 270/271, 834)
• Demonstrated ability to identify process gaps and recommend solutions independently
• Self-directed with initiative to drive projects and escalate issues appropriately
• Strong analytical skills with experience resolving complex data issues
• Proven decision-making in ambiguous situations using available data
• Demonstrated creativity and proactive approach to managing tasks and inventory
• Committed to improving business outcomes through continuous improvement
• Proficient in oral and written communication
• Collaborative with strong relationship-building and stakeholder engagement skills
• Familiar with healthcare industry regulations or adjacent sectors

Preferred Qualifications

• Comprehensive knowledge of Medicare, Medicaid, and DSNP encounter processes and policies.
• Working knowledge of advanced analytics and experience with Python and DataBricks.
• Working knowledge of Cloud Technologies (Azure Synapse Analytics) and Power Platform (Power BI)
• Experience creating pivot tables and consumable information within Excel

Additional Information

Work-At-Home Requirements

• Must have the ability to provide a high-speed DSL or cable modem for a home office.
• Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

• As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability.
• HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.
• If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment.
• You will have a set of questions, and you will provide responses to each question.
• You should anticipate this to take about 15 - 20 minutes.
• Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to the next round.

Travel

• While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Employment Details

• Employment Type: Full time
• Scheduled Weekly Hours: 40
• Pay Range: The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower.