[Remote] Encounter Data Management Professional at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Experience managing end-to-end business processes in the medical Encounter space
Minimum 1 year of prior financial reporting and/or related finance experience
2 or more years of experience using DOS type systems
Strong analysis, critical thinking, and analytical problem-solving skills
Ability to manage multiple tasks and deadlines with attention to detail
Excellent verbal and written communication skills
Comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and Excel
Ability to provide a high-speed DSL or cable modem for a home office (minimum 25mbps download x 10mbps upload; no satellite or wireless internet)
Dedicated home office space lacking ongoing interruptions to protect member PHI / HIPAA information
Preferred Qualifications
Prior health insurance industry experience
Working knowledge of Microsoft SQL or SAS
Medicare and/or Medicaid experience

Responsibilities

Ensure accurate submission and reconciliation of encounter data to Medicaid and Medicare through effective business processes
Ensure claims 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 claims submission processes
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
Develop business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare
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 be assigned additional projects, stretch assignments and/or additional duties
Independently set priorities and make decisions on work approach while following established direction, managed by precedent and/or documented procedures/regulations/professional standards with some interpretation

Skills

Key technologies and capabilities for this role

Encounter Data ManagementMedicaidMedicareCMSClaims SubmissionData AnalysisClaims ResearchData ReconciliationBusiness Process DevelopmentCompliance StandardsData Integrity

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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