[Remote] Medicaid Reconciliation Professional II at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Undergraduate degree
Minimum 3 years of experience in Medicaid reconciliation, enrollment, or healthcare claims auditing
Minimum 3 years of experience with process improvement initiatives or change management in a healthcare setting
Demonstrated experience with data analysis and reporting tools (e.g., Excel, Access, or similar)
Proficiency in Microsoft Office Suite, especially Excel (pivot tables, VLOOKUP, formulas)
Familiarity with Medicaid systems, claims platforms, and reconciliation tools
Minimum download speed of 25 mbps and upload speed of 10 mbps

Responsibilities

Gather and evaluate Medicaid eligibility data to identify discrepancies and opportunities for process optimization and state submissions
Collaborate with the Senior Professional and Leads and recommend and implement business practices that improve reconciliation efficiency, reduce errors, and support regulatory compliance
Assess how new systems and tools can streamline Medicaid reconciliation processes and support automation efforts
Share feedback with the Senior Business Systems analysis associate for appropriate fix implementation
Understand departmental and organizational goals, ensuring reconciliation processes align with broader Medicaid and healthcare compliance strategies
Exercise independent judgment in routine tasks and contribute to problem-solving in ambiguous situations with minimal supervision
Follow established procedures while identifying areas for improvement and innovation
Reconcile Medicaid claims and payments accurately and within reporting deadlines
Reduce reconciliation errors or mismatches year-over-year
Successfully implement and sustain process improvement initiatives
Ensure adherence to Medicaid regulations and audit requirements

Skills

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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