Encounter Data Management Professional

Position Overview

Become a part of our caring community and help us put health first. The Encounter Data Management Professional ensures data integrity for claims errors. Your work assignments will be varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

• 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.
• Look for long-term improvements of encounter submission processes.
• Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.
• Follow established guidelines/procedures.

Requirements

• 1-5 years or more of claims processing or auditing experience.
• Minimum of 1 year's 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.
• Demonstrated ability to apply strong analytical, critical thinking, and problem-solving skills to complex challenges.
• Proven track record of managing multiple tasks and meeting deadlines with a high level of accuracy and attention to detail.
• Excellent written and verbal communication skills, with a demonstrated ability to convey complex information clearly and effectively.
• 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.
• Encounter Submission experience.
• CAS, Edifecs experience.
• X12 experience.
• Prior health insurance industry experience.
• Working knowledge of Microsoft SQL or SAS.

Employment Type

• Full-time

Location Type

• Remote

Pay Range

• $65,000 - $88,600 per year
• This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Additional Information

Interview Format

As part of our hiring process, we will be using interviewing technology provided by HireVue. If selected to move forward, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. Pre-recorded interviews are expected 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 California will be provided payment for their internet expense.
• A minimum standard speed of 25mbps download x 10mbps upload is required.
• Satellite and Wireless Internet service is NOT allowed.
• 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.