[Remote] Senior Encounter Data Management Professional at Humana

San Antonio, Texas, United States

Humana Logo
Not SpecifiedCompensation
Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, HealthcareIndustries

Requirements

Candidates must have 3 or more years of Medicare and/or Medicaid claims processing or auditing experience, along with over 1 year of leadership, coaching, or team leadership experience. A minimum of 1 year of experience working in CAS and CI, along with 1 year of X-12 data knowledge is preferred. Prior demonstrated experience with project management and working knowledge of SQL writing, creating, and/or running queries (ORACLE, Microsoft SQL Server) are also preferred qualifications. Candidates should possess comprehensive knowledge of all Microsoft Office applications, including Word, PowerPoint, Outlook, and intermediate Excel skills. A Bachelor's degree in Business, Finance, Operations, or other related fields is preferred. The role requires the ability to manage multiple tasks and deadlines with attention to detail, excellent communication skills, and the ability to work independently and manage multiple priorities simultaneously. For remote work, a high-speed DSL or cable modem with a minimum speed of 25mbps download and 10mbps upload is required, and satellite or wireless internet service is not allowed.

Responsibilities

The Senior Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation of encounter submissions to Medicaid/Medicare, ensuring compliance standards are met or exceeded through data analysis. They develop tools to enhance encounter acceptance rates and identify long-term improvements for encounter submission and error correction processes. This role involves leading a team of 2-5 associates, serving as a subject matter expert for error corrections teams, and facilitating collaborative meetings to provide status updates. The professional presents summaries of inventory, successes, and concerns to internal business partners, serves as a point of contact for special projects, and identifies opportunities for process improvements. They also provide ongoing support and training to direct reports and production associates, and make decisions on complex issues regarding technical approach and error correction resolution, influencing departmental strategy.

Skills

Encounter Data Management
Business Process Development
Data Analysis
Compliance Standards
Error Correction
Medicare
Medicaid
Team Leadership
Technical Approach
Problem-Solving
Communication

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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