Encounter Data Management Professional

Employment Type: Full time Pay Range: $65,000 - $88,600 per year Scheduled Weekly Hours: 40

Position Overview

Become a part of our caring community and help us put health first. The Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare. Ensures encounter submissions meet or exceed all compliance standards via analysis of data and develops tools to enhance the encounter acceptance rate by Medicaid/Medicare. Looks for long-term improvements of encounter submission processes. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. The Encounter Data Management Professional ensures data integrity for claims errors. 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.

Requirements

• Required Qualifications:
  • 1 - 5 years or more of claims processing experience
  • Minimum of 1 year experience in conducting thorough root cause analysis and resolution
  • Document project processes to ensure all aspects are captured for future reference in a clear and detailed manner
  • 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
• Preferred Qualifications:
  • Bachelor's degree in Business, Finance, Accounting, Operations or other related fields
  • X12 experience
  • Prior health insurance industry experience
  • Working knowledge of Microsoft SQL or SAS

Responsibilities

• Develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare.
• Ensures encounter submissions meet or exceed all compliance standards via analysis of data.
• Develops tools to enhance the encounter acceptance rate by Medicaid/Medicare.
• Looks for long-term improvements of encounter submission processes.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follows established guidelines/procedures.
• Ensures data integrity for claims errors.
• Work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Additional Information

• Interview Format: As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
• 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 (25mbps download x 10mbps 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.
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
• Bonus Incentive: This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Company Information

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions.