Encounter Data Management Professional at Humana

Indiana, Pennsylvania, United States

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Not SpecifiedCompensation

Entry Level & New GradExperience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

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
Demonstrated understanding of healthcare data exchange formats and industry standards (e.g., CSV, XML, JSON, or other structured data)
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

Responsibilities

Conduct research and analysis to execute accurate, timely, and complete DSNP encounter submissions
Apply comprehensive knowledge of processes, policies, procedures, and compliance guidelines
Support achieving operational and compliance key performance indicators
Participate in cross-functional teams
Support analyzing business processes, error processing, issues, and ticket creations with the product management team
Support encounter processing, analytics, and research of encounter submission inventory

Skills

Key technologies and capabilities for this role

Microsoft ExcelMicrosoft AccessSQLCSVXMLJSONmedical claims processinghealthcare data exchangeanalytical skillsprocess improvement

Questions & Answers

Common questions about this position

What are the required qualifications for this role?

Minimum 1 year of experience in medical claims payment and processing, minimum 1 year analyzing and researching medical claims, proficient in Microsoft Office (Word, Excel, Access, PowerPoint), working knowledge of SQL, and demonstrated understanding of healthcare data exchange formats like CSV, XML, JSON.

Is this a remote position, and what are the work-at-home requirements?

This is a work-at-home role requiring a high-speed DSL or cable modem with minimum speeds of 25 Mbps download and 10 Mbps upload; satellite and wireless internet are not allowed. Associates in California receive payment for internet expenses.

What is the salary or compensation for this position?

This information is not specified in the job description.

What does the company culture emphasize for this role?

The role involves joining a caring community focused on putting health first, with emphasis on collaboration, cross-functional teamwork, continuous improvement, and proactive problem-solving.

What makes a strong candidate for this position?

Strong candidates demonstrate self-direction, strong analytical skills, independent decision-making in ambiguous situations, creativity, proactive task management, and excellent communication with stakeholder engagement.

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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