Encounter Data Management Professional

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health InsuranceIndustries

Requirements

Candidates must have 1-5+ years of experience in claims processing and at least 1 year of proven success in root cause analysis and resolution. Strong analytical and critical thinking abilities, clear and thorough process documentation skills, the ability to manage multiple priorities with attention to detail, and excellent communication skills are required. Proficiency in Microsoft Office (Word, PowerPoint, Outlook, Excel) is necessary. A Bachelor's degree in business, finance, accounting, operations, or a related field, X12 experience, and working knowledge of Microsoft SQL or SAS are preferred. Candidates must also be able to provide a high-speed DSL or cable modem for a home office, with a minimum speed of 25mbps download and 10mbps upload, and have a dedicated, interruption-free workspace.

Responsibilities

The Encounter Data Management Professional will ensure data integrity for claims errors and develop business processes for successful submission and reconciliation of encounter submissions to Medicaid/Medicare. They will analyze data to ensure encounter submissions meet or exceed compliance standards, develop tools to enhance the encounter acceptance rate, and identify long-term improvements for encounter submission processes. The role involves interpreting varied work assignments, determining appropriate courses of action, understanding department and organizational strategy, and making decisions regarding work methods with minimal direction.

Skills

Claims processing

Root cause analysis

Process documentation

Analytical skills

Critical thinking

Attention to detail

Communication skills

Microsoft Office

Microsoft Word

Microsoft PowerPoint

Microsoft Outlook

Microsoft Excel

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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