Humana

Encounter Data Management Professional

San Antonio, Texas, United States

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 experience in claims processing and at least 1 year of proven success in root cause analysis and resolution. Strong analytical, critical thinking, and communication skills are essential, along with proficiency in Microsoft Office (Word, PowerPoint, Outlook, Excel). Preferred qualifications include a Bachelor's degree in business, finance, accounting, or operations, X12 experience, prior health insurance industry experience, and working knowledge of Microsoft SQL or SAS. Home office requirements include a high-speed DSL or cable modem with a minimum speed of 25mbps download and 10mbps upload; satellite and wireless internet are not permitted. Occasional travel may be required.

Responsibilities

The Encounter Data Management Professional ensures data integrity for claims errors and develops business processes for successful submission and reconciliation of encounter data to Medicaid/Medicare. This role involves analyzing data to ensure submissions meet compliance standards, developing tools to improve encounter acceptance rates, and identifying long-term process improvements. The professional will interpret changes in legislation, make independent decisions regarding work methods, and follow established guidelines.

Skills

claims processing
root cause analysis
process documentation
analytical skills
critical thinking
priority management
attention to detail
communication skills
Microsoft Office
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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