Encounter Data Management Professional

About the Role

Employment Type: Full time

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 own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

Humana’s Encounter Data Management (EDM) team is seeking an Encounter Data Management Professional that has experience with business processing and data entry to join working remote anywhere in the US. As the Encounter Data Management Professional, you will identify complex errors and problems within the encounter process between Humana and CMS using data analysis, claims research, and other resources to provide insight and ensure data integrity for Medicare/Medicaid claims errors.

Key Role Functions

• 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
• Maintain partnership with departments and communicate with the leadership of those departments to highlight impacts that will result in change by the responsible department that ultimately will decrease the amount of errors
• May attend Medicaid/Medicare state partner meetings
• May be assigned additional projects, stretch assignments and/or additional duties

Use your skills to make an impact.

Required Qualifications

• 3+ years of data processing experience
• Prior financial reporting and/or related finance experience
• Proficient in DOS-based systems and environments
• Demonstrated ability to perform in-depth analysis and apply critical thinking to solve complex problems
• Effectively manages multiple tasks and competing deadlines with precision and attention to detail
• Communicates clearly and confidently in both written and verbal formats, fostering understanding and collaboration
• Comprehensive knowledge of all Microsoft Office applications, including Word, SharePoint, PowerPoint and Outlook, Excel

Preferred Qualifications

• Prior health insurance industry experience
• Working knowledge of Microsoft SQL or SAS
• Medicare and/or Medicaid experience

Additional Information

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

Our Hiring Process

As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round.