Senior Data Analyst
Thrive MarketFull Time
Senior (5 to 8 years)
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.
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.
Health insurance provider for seniors and military
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.