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 Insurance, HealthcareIndustries

Requirements

Candidates should possess 3+ years of data processing experience, prior financial reporting or related finance experience, and proficiency in DOS-based systems. They must demonstrate an ability to perform in-depth analysis and critical thinking, manage multiple tasks with attention to detail, and communicate effectively both verbally and in writing. Comprehensive knowledge of Microsoft Office applications, including Word, SharePoint, PowerPoint, Outlook, and Excel, is required. Preferred qualifications include health insurance industry experience, working knowledge of Microsoft SQL or SAS, and Medicare and/or Medicaid experience. Home office requirements include a high-speed DSL or cable modem with a minimum speed of 25mbps download and 10mbps upload, and a dedicated, interruption-free workspace.

Responsibilities

The Encounter Data Management Professional will develop business processes for successful submission and reconciliation of encounter data to Medicaid/Medicare, ensuring compliance with all standards through data analysis. They will create tools to improve encounter acceptance rates, identify long-term improvements for submission processes, and maintain partnerships with departments to highlight impacts on error reduction. This role involves analyzing complex errors and problems within the encounter process using data analysis and claims research to ensure data integrity for Medicare/Medicaid claims errors.

Skills

Encounter Data Management

Business Process Development

Data Analysis

Claims Research

Data Integrity

Compliance Standards

Data Entry

Medicaid

Medicare

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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