Humana

Senior Encounter Data Management Professional

San Antonio, Texas, United States

Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, HealthcareIndustries

Requirements

Candidates must possess 5+ years of experience in medical claims processing, auditing, or encounter data management. Required qualifications include demonstrated deep dive research and analysis skills, prior experience in a fast-paced insurance or healthcare setting, and proven experience working with Medicare and Medicaid programs. The role also requires the ability to manage multiple tasks and deadlines with attention to detail, and the capacity to work independently as a self-starter. A high-speed DSL or cable modem is necessary for remote work, with a minimum speed of 25mbps download and 10mbps upload, and satellite or wireless internet is not permitted. A dedicated, interruption-free space is also required to protect member PHI/HIPAA information.

Responsibilities

The Senior Encounter Data Management Professional is responsible for developing business processes to ensure the successful submission and reconciliation of encounter data to Medicaid/Medicare, meeting or exceeding all compliance standards through data analysis. They will develop tools to improve the encounter acceptance rate and drive long-term improvements in encounter submission processes. This role involves ensuring data integrity for claims errors resulting from data exchange with trading partners, Medicare, and Medicaid. The professional will collaborate with department leadership, trading partner owners, and the error resolution team to address and improve error submission issues. They will also be tasked with problem-solving and removing roadblocks that hinder timely encounter data submission to trading partners. This includes analyzing data, trends, and system limitations to create and implement long-term improvements that enhance encounter submissions, addressing moderately complex to complex issues requiring in-depth evaluation of variable factors.

Skills

Encounter Data Management
Claims Processing
Auditing
Data Analysis
Business Process Development
Compliance Standards
Error Resolution
Trend Analysis
System Limitations

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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